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Cost-Effectiveness of Pediatric Cochlear Implantation in Rural China
Jianxin Qiu1, Chongxian Yu, Thathya V Ariyaratne
1*The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, P. R. China †Cochlear Limited Macquarie University, NSW, Australia.
Insights
Cochlear implantation (CI) is a cost-effective solution for children with severe to profound sensorineural hearing loss (SNHL) in rural China. This hearing intervention offers significant quality-adjusted life year (QALY) gains, supporting broader insurance coverage.
Area of Science:
- Otolaryngology
- Health Economics
- Pediatric Audiology
Background:
- Severe to profound sensorineural hearing loss (SNHL) significantly impacts children's development and educational attainment.
- Access to effective hearing interventions is crucial for improving outcomes in pediatric populations, particularly in underserved rural areas.
Purpose of the Study:
- To evaluate the cost-utility of unilateral cochlear implantation (CI) for children with severe to profound SNHL in rural China.
- To compare the cost-effectiveness of CI against no treatment or hearing aid amplification.
Main Methods:
- A cost-utility analysis (CUA) was conducted using data from the Cochlear Pediatric Implanted Recipient Observational Study (Cochlear P-IROS).
- A decision tree model projected costs and quality-adjusted life years (QALYs) over a 20-year time horizon.
- The analysis adopted Chinese healthcare payer and patient perspectives.
Main Results:
- Unilateral CI yielded an incremental cost-effectiveness ratio (ICER) of CNY 100,561 ($15,084 USD) per QALY gained from a combined payer-patient perspective.
- From a healthcare payer perspective, the ICER was CNY 40,929 ($6,139 USD) per QALY.
- Both ICERs were within the range considered cost-effective by WHO standards, falling within one to three times China's GDP per capita.
Conclusions:
- Unilateral CI is a cost-effective hearing solution for children with severe to profound SNHL in rural China.
- CI can lead to improved educational access and employment opportunities, generating further societal and economic benefits.
- Consideration for broader inclusion of CI in Chinese medical insurance schemes is recommended.
Objectives:
To evaluate the cost utility of cochlear implantation (CI) for severe to profound sensorineural hearing loss (SNHL) among children from rural settings in P.R. China (China).
Research Design:
A cost-utility analysis (CUA) was undertaken using data generated from a single-center substudy of the Cochlear Pediatric Implanted Recipient Observational Study (Cochlear P-IROS). The data were projected over a 20-year time horizon using a decision tree model.
Setting:
The Chinese healthcare payer and patient perspectives were adopted.
Intervention:
Unilateral CI of children with a severe-to-profound SNHL compared with their preimplantation state of no treatment or amplification with hearing aids ("no CI" status).
Main Outcome Measure/S:
Incremental costs per quality adjusted life year (QALY) gained.
Results:
The mean total discounted cost of unilateral CI was CNY 252,506 (37,876 USD), compared with CNY 29,005 (4,351 USD) for the no CI status from the healthcare payer plus patient perspective. A total discounted benefit of 8.9 QALYs was estimated for CI recipients compared with 6.7 QALYs for the no CI status. From the healthcare payer plus patient perspective, incremental cost-effectiveness ratio (ICER) for unilateral CI compared with no CI was CNY 100,561 (15,084 USD) per QALY. The healthcare payer perspective yielded an ICER of CNY 40,929 (6,139 USD) per QALY. Both ICERs fell within one to three times China's gross domestic product per capita (GDP, 2011-2015), considered "cost-effective" by World Health Organization (WHO) standards.
Conclusions:
Treatment with unilateral CI is a cost-effective hearing solution for children with severe to profound SNHL in rural China. Increased access to mainstream education and greater opportunities for employment, are potential downstream benefits of CI that may yield further societal and economic benefits. CI may be considered favorably for broader inclusion in medical insurance schemes across China.