A Cost‐Utility Analysis of Pediatric Cochlear Implantation

Abstract

Objective/Hypothesis: The aim of this study was to explore the cost-utility of pediatric cochlear implantation, incorporating savings associated with ed· ucation into the analysis. Methods: The costs of pedi· atric cochlear implantation were based on the full costs levied to purchasers, inclusive of complications and maintenance, by a large pediatric cochlear im· plant program in the United Kingdom. After implantation, profoundJy hearing-impaired children have been found to develop hearing threshold levels equiv· alent to severely hearing-impaired children who wear hearing aids. An independent study calculated the educational costs for severely hearing-impaired and profoundJy hearing-impaired children. From this study, savings in ducational costs that would result from enabling the profoundly hearing-impaired to function as severely bearing-impaired were deter· mined. Cost-utility was established conservatively by applying to children the known gains in utility re· ported by adults with cochlear implants. Results: The discounted costs of creating a pediatric cochlear im· plant user and of maintaining the child over the first 12 years were £48,757 ($78,011). The discounted differ· ence in education costs associated with a profoundJy hearing-impaired child (IIL >95 dB) as compared with a sever ly hearing-impaired child over the same period was £26, 781 ($42,850). These rep· r sent the potential savings in educational costs asso· ciated with pediatric cochlear implantation. Assum· ing implantation at age 4 years, the discounted net average cost of pediatric cochlear implantation over compulsory chool years (ages 4-16) was £21,976 ($35,162). Cochlear implants have been shown to improve the quaJity of life in adults by 0.23 points per annum (where quality of life is rated on a scale from 0 to 1). Applying this weight to children r ceiving im· plantation at age 4 years, and assuming a life expectancy of 74 years, the quality-adjusted life-year (QALY) 156 gain is calculated to be 16.33. The cost per undis· counted QALY gain was estimated to b e £1,345.70 ($2153.12) and per discounted QALY gain to be £10,341 ($16,545.60). Conclusion: This study provides evidence, based on conservative assumptions, to support the view that pediatric cochlear implantation is a cost-effective health care intervention in profoundJy hearing-impaired young children.

Hearing-Impaired Children in the United Kingdom, IV: Cost-Effectiveness of Pediatric Cochlear Implantation

“…For children with the mean AHL of the sample (115 dB), implantation was associated with a mean gain in health utility which varied from ϩ0.13 to ϩ0.26, depending on the age of the child at implantation and the duration of implant use. These values straddle the gain of ϩ0.20, which was measured, also using the HUI3 questionnaire, in two studies of adults (Palmer, Niparko, Wyatt, Rothman, & de Lissovoy, 1999;UK Cochlear Implant Study Group, 2004), and which has been adopted as the starting point in some studies of children (Hutton et al, 1995;O'Neill et al, 2000;Summerfield & Marshall, 1995;Summerfield et al, 1997). Our estimates are lower, however, than the gain of ϩ0.39 estimated by Cheng et al (2000) when parents completed the HUI3 questionnaire retrospectively for their children.…”

“…Other studies (e.g., Hutton et al, 1995;O'Neill et al, 2000;Summerfield, & Marshall, 1995;Summerfield et al, 1997) inferred the gain in utility for children from the gain measured with adults, which may be inappropriate because the effect of implantation for prelingually deafened children may differ in kind and degree from the effect for postlingually deafened adults (Summerfield & Marshall, 1995;Cheng et al, 2000). Cheng et al (2000) asked the parents of 78 children who had received implants in a single hospital in the United States to judge, retrospectively, what their children's health utility had been before implantation and to judge how it was currently after implantation.…”

“…In line with Barton et al (2003), we judged that 15 yr is the minimum length of time for which implants will be used by children before being superseded by new interventions. A child's lifetime is the maximum period over which the costs and benefits of cochlear implantation could accrue, and is the period incorporated in previous estimates of the cost-effectiveness of pediatric cochlear implantation (Cheng et al, 2000;Hutton et al, 1995;O'Neill et al, 2000;Summerfield & Marshall, 1995;Summerfield et al, 1997;Wyatt et al, 1995).…”

“…An alternative interpretation is that parents who have witnessed a change in their child's health utility may be sensitized to the states described in the HUI3 questionnaire and may make more accurate judgments as a result. Societal Costs • Three previous studies (Cheng et al, 2000;O'Neill et al, 2000;Schulze-Gattermann et al, 2002) have estimated the incremental cost of pediatric cochlear implantation in domains outside the health sector. From the viewpoint of the health and education sectors together, the incremental cost has been estimated to be €55,133 (exchange rate US $1.20 ϭ €1.00) in the United Kingdom (O'Neill et al, 2000;1997/8 prices, 6% discount rate), between €46,000 and €57,000 in Germany (up to age 16 yr) (Schulze-Gattermann et al, 2002;1999 prices, 6% discount rate), and equivalent to a cost saving of US $5,330 (€4,442) in the United States (Cheng et al, 2000; prices, 3% discount rate).…”

“…Several studies have used measures of health utility to assess the cost-effectiveness of pediatric cochlear implantation (Cheng, Rubin, Powe, Mellon, Francis, & Niparko, 2000;Hutton, Politi, & Seeger 1995;O'Neill, O'Donoghue, Archbold, & Normand, 2000;Summerfield & Marshall, 1995;Summerfield, Marshall, & Archbold, 1997;Wyatt, Niparko, Rothman, & De Lissovoy, 1995). All of these studies concluded that pediatric implantation was acceptably costeffective, but none estimated how cost-effectiveness varied among candidates.…”