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Updated: May 12, 2026
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Age-dependent cost-utility of pediatric cochlear implantation
Yevgeniy R Semenov1, Susan T Yeh, Meena Seshamani
1Department of Otolaryngology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Early cochlear implantation (CI) for children with severe-to-profound hearing loss offers significant long-term societal benefits. Younger children implanted before 18 months achieved better quality of life and educational outcomes, demonstrating favorable cost-utility ratios.
Area of Science:
- Pediatric Otolaryngology
- Health Economics
- Societal Impact of Medical Interventions
Background:
- Cochlear implantation (CI) is a primary treatment for pediatric severe-to-profound sensorineural hearing loss (SNHL).
- While clinical benefits of early CI are known, long-term societal and economic impacts across different implantation ages require further investigation.
- Optimal timing for CI is a critical decision for parents and clinicians, influencing long-term outcomes.
Purpose of the Study:
- To evaluate the societal economic consequences of pediatric cochlear implantation based on the age at intervention.
- To analyze the cost-utility of pediatric CI across various age groups.
- To compare the long-term health utility and educational placement outcomes associated with different CI timing.
Main Methods:
- Prospective, longitudinal study of 175 children with SNHL undergoing CI before age 5.
- Assessment of health utility and educational placement over up to 6 years post-implantation.
- Retrospective cost analysis stratified by care phases, comparing implantation ages and a non-implantation baseline.
Main Results:
- Children implanted before 18 months gained 10.7 QALYs, compared to 9.0 and 8.4 for older groups.
- Mainstream classroom integration was significantly higher in the youngest group (81%) vs. older groups (57-63%).
- CI resulted in net societal savings: $31,252 (youngest), $10,217 (middle), and $6,680 (oldest) over a lifetime.
Conclusions:
- Early CI (<18 months) yields superior quality-of-life improvements and educational outcomes.
- Direct costs of implantation and complication rates were similar across age groups.
- Early intervention demonstrates highly favorable cost-utility ratios and significant long-term societal economic value.
Objectives:
Cochlear implantation (CI) has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence of the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation-a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the present study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost utility of pediatric CI by age at intervention will be analyzed.
Design:
Prospective, longitudinal assessment of health utility and educational placement outcomes in 175 children recruited from six U.S. centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent CI before 5 years of age, and had up to 6 years of postimplant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratified by preoperative, operative, and postoperative expenditures. Incremental costs and benefits of implantation were compared among the three age groups and relative to a nonimplantation baseline.
Results:
Children implanted at <18 months of age gained an average of 10.7 quality-adjusted life years (QALYs) over their projected lifetime as compared with 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different among the three age groups. In addition, mean lifetime costs of implantation were similar among the three groups, at approximately $2000/child/year (77.5-year life expectancy), yielding costs of $14,996, $17,849, and $19,173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared with 57 and 63% for the middle and oldest groups, respectively (p < 0.05) after 6 years of follow-up. After incorporating lifetime educational cost savings, CI led to net societal savings of $31,252, $10,217, and $6,680 for the youngest, middle, and oldest groups at CI, respectively, over the child's projected lifetime.
Conclusions:
Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with CI was associated with greater and longer quality-of-life improvements, similar direct costs of implantation, and economically valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to CI at older ages.