Abstract2018 Fellowship of Postgraduate Medicine Objective: To evaluate the influence of a health technology assessment (HTA) on pediatric cochlear implantation (CI) in Kazakhstan and to provide a further perspective on the use of the technology in that country. Ideally, children should be implanted as young as possible, have adequate rehabilitation, and be integrated into the regular school system. Methods: Administrative data for 2013-2016 relevant to pediatric CI in Kazakhstan were obtained from the Ministry of Health and from a survey of authorities in the 16 regions of the country. The data were compared with those for 2007-2012 used in preparation of the HTA report. Results: Funding continued to be available only for unilateral CI, a clinical protocol for the procedure was finalized and availability of equipment for audiological screening had improved considerably. In Kazakhstan the proportion of children over 5 years old at implantation had decreased by 65%, while that for children less than 2 years old had increased from 12 to 35%. Rehabilitation of children post-implantation was limited by the small numbers of suitable specialists. There was an increase in numbers of children enrolled in schools for those with moderate or profound hearing impairment. The number of children educated in standard schools remains low. Conclusion: The HTA made a useful contribution to the development of cochlear implantation services in Kazakhstan. The shortage of specialists for provision of rehabilitation and the limited placement of implanted children in general schools are matters for government decision -makers to consider.

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Submit Manuscript | http://medcraveonline.com Cochrane. Included studies covered a period from last ten years, all child from 0-18 years old, limited English language. By discussion of two reviewers we included unilateral CI in children for quality of life and clinical effectiveness.Results: The literature review shows the effectiveness and improvement in the quality of life of children with a cochlear implant, which is expressed by improving speech recognition and perception in children, also development of lexical, auditory and speech activity was largely due to the variability of communication and the quality of life. Correlations in the communication variable show a direct relationship between the oral message and the quality of life. Conclusion:The literary review revealed a lack of research on the quality of life of children with CI in Kazakhstan. Our further research involves studying the quality of life of children with CI using a questionnaire EQ5D.

INTRODUCTION:The State Program for Health Development of the Republic of Kazakhstan (RK) “Densaulyk” for 2016–2019 initiated the modernization of primary health care with the introduction of family practice in order to ensure the availability, completeness and quality of health services on the basis of an integrated healthcare system focused on the needs of the population. The aim of this study was to determine the effectiveness of the cochlear implantation (CI) programs.METHODS:A literature search was conducted for all clinical trials, randomized controlled trials, and reviews in the PubMed, Cochrane, and Center for Reviews and Dissemination databases. Two reviewers independently evaluated all publications for selection. The analysis included the cost-effectiveness and benefit from the CI program.RESULTS:We analyzed the effectiveness of the services for CI in the RK and other countries (1). In our analysis, we identified that there is no research on Quality-adjusted Life Years (QALYs) and Cost-Utility Analysis (CUA) in RK. We found that, in general, the cost of CI and pre-surgical procedures are comparable with other countries. The length of stay in Kazakhstan was much higher (an average of 8 days) compared with other countries (3 days). Also in RK, there were significantly lower prices per hospital day and cost of various consultations. Postoperative costs of other countries consisted of one-third to two-thirds of the total costs for preoperative and implantation stages (2, 3). There was a little information on the effectiveness of rehabilitation programs in RK.CONCLUSIONS:Economic research like QALYs and CUA are new directions in the healthcare system in the RK. Lack of integration between primary care, rehabilitation and other services leads to difficulties in assessing the effectiveness of CI programs (for example, in our case, there was the restriction of assessment in only postoperative costs).