Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada

Objectives To investigate provincial cochlear implantation (CI) annual volume and cost trends. Study Design Database analysis. Setting National surgical volume and cost database. Subjects and Methods Aggregate-level provincial CI volumes and cost data for adult and pediatric CI surgery from 2005 to 2014 were obtained from the Canadian Institute for Health Information. Population-level aging forecast estimates were obtained from the Ontario Ministry of Finance and Statistics Canada. Linear fit, analysis of variance, and Tukey's analyses were utilized to compare variances and means. Results The national volume of annual CI procedures is forecasted to increase by <30 per year ( R² = 0.88). Ontario has the highest mean annual CI volume (282; 95% confidence interval, 258-308), followed by Alberta (92.0; 95% confidence interval, 66.3-118), which are significantly higher than all other provinces ( P < .05 for each). Ontario's annual CI procedure volume is forecasted to increase by <11 per year ( R² = 0.62). Newfoundland and Nova Scotia have the highest CI procedures per 100,000 residents as compared with all other provinces ( P < .05). Alberta, Newfoundland, and Manitoba have the highest estimated implantation cost of all provinces ( P < .05). Conclusions Historical trends of CI forecast modest national volume growth. Potential bottlenecks include provincial funding and access to surgical expertise. The proportion of older adult patients who may benefit from a CI will rise, and there may be insufficient capacity to meet this need. Delayed access to CI for pediatric patients is also a concern, given recent reports of long wait times for CI surgery.