Cost-Benefit Analysis of Pediatric Cochlear Implantation: German Experience

Schulze-Gattermann, Heide; Illg, Angelika; Schoenermark, M.; Lenarz, Thomas; Lesinski‐Schiedat, Anke

doi:10.1097/00129492-200209000-00013

Cited by 47 publications

(62 citation statements)

References 10 publications

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“…The second analysis also allowed comparisons with results reported by O'Neill et al (2000) and Schulze-Gattermann, et al (2002).…”

Section: Ear and Hearing / October 2006mentioning

confidence: 80%

“…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).…”

Section: Comparisons With Other Studiesmentioning

confidence: 99%

“…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). These estimates are lower than our summation of the lifetime incremental costs in the health and education sectors, which range between €89,170 (for a child implanted at age 3, with a preoperative loss of 125 dB) and €118,616 (for a child implanted at age 6, with a preoperative loss of 105 dB) ( Table 5).…”

Section: Comparisons With Other Studiesmentioning

confidence: 99%

“…A secondary aim was to examine differences in cost-effectiveness between different groups of candidates for implantation. Justification for this secondary aim is provided by evidence that the clinical and demographic characteristics of children influence many outcomes from implantation, including speech perception (e.g., Miyamoto, Osberger, Robbins, Myres, & Kessler, 1993;Tyler, Fryauf-Bertschy, Gantz, Kelsay, & Woodworth, 1997), spoken language, auditory performance, speech intelligibility, academic abilities , and the cost of education (Barton, Stacey, Fortnum, & Summerfield, 2006a;Schulze-Gattermann, Illg, Schoenermark, Lenarz, & Lesinski-Schiedat, 2002). It is possible therefore that the cost-effectiveness of implantation also varies according to the characteristics of the child.…”

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confidence: 99%

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

et al. 2006

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Objective: To estimate the cost-effectiveness of pediatric cochlear implantation by conducting a costutility analysis from a societal perspective. Design:In a cross-sectional survey, the parents of a representative sample of hearing-impaired children assessed the health utility of their child using a revised version of the Health Utilities Index Mark III questionnaire. Linear regression was used to estimate the gain in health utility associated with implantation while controlling for eight potentially confounding variables: average (4-frequency, unaided, preoperative) hearing level (AHL), age at onset of hearing-impairment, age, gender, number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The gain in health utility was accumulated to estimate the number of quality-adjusted life years (QALYs) that would be gained from implantation over 15 yr and over a child's lifetime. The incremental societal cost of implantation, calculated in euros (€) at 2001/2 levels, was estimated by summing the incremental costs of implantation that are incurred in the health sector, in the education sector, and by the child's family. The cost-effectiveness of cochlear implantation was estimated by calculating the incremental societal cost per QALY gained and was compared with an upper limit of acceptability of €50,000 per QALY. Results:The parents of 403 implanted children, and 1863 nonimplanted children, completed the health utility questionnaire. Higher health utility was associated with a more favorable AHL, an older age at onset of hearing impairment, female gender, having fewer additional disabilities, having parents with a greater occupational skill level, white ethnicity, and implantation. The gain in health utility associated with implantation was estimated to be higher for children with a worse preoperative AHL and who were implanted when younger. Over 15 yr, for a child implanted at age 6 with a preoperative loss of 115 dB, 2.23 QALYs were estimated to be gained, compared with a mean incremental societal cost of €57,359, yielding a mean cost per QALY of €25,629.Cost-effectiveness was more favorable: (1) when estimated over a child's lifetime rather than 15 yr, (2) for children with a worse preoperative AHL, and (3) for children who were implanted when younger. Conclusions:The mean cost of gaining a QALY for the children in the present sample falls within acceptable limits. The strategy of giving highest priority for implantation to children with the greatest loss of hearing, and who are younger, maximizes benefit for a given cost.

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“…The second analysis also allowed comparisons with results reported by O'Neill et al (2000) and Schulze-Gattermann, et al (2002).…”

Section: Ear and Hearing / October 2006mentioning

confidence: 80%

Section: Comparisons With Other Studiesmentioning

confidence: 99%

Section: Comparisons With Other Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2006

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“…This is mainly due to the close interrelation between the hearing system and other brain areas and functions [31] ( Figure 35). In cases of early implantations, about 2/3 of the children may visit regular schools [58]. The professional education is usually also significantly facilitated by cochlear implant.…”

Section: Childrenmentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of Thomas Lenarz 1 inner hair cells by transforming the acoustic signal into electrical stimuli in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.Keywords: cochlear implant, sensory deafness, diagnostics, surgical procedure, results, complications, future developments SummaryCochlear implants are electronical stimulus prostheses for the functional replacement of the inner ear. Because of the rapid technical development and the good results, they could be established as standard therapy for sensory deafness. Cochlear implantation requires an interdisciplinary team and a quality-controlled concepts that reaches from the indication to the life-long control and that is fixed in the AWMF guideline on cochlear implant [1]. Current cochlear implant systems are partially implantable and equipped with a multitude of additional functions similar to hearing aids for sound pre-processing and noise elimination. The intracochlear position of the electrode allows fo...

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Estimated net saving to society from cochlear implantation in infants: A preliminary analysis

et al. 2011

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Cost-Benefit Analysis of Pediatric Cochlear Implantation: German Experience

Abstract: This study supports the view that pediatric cochlear implantation provides positive cost-benefit ratios compared with hearing aid users, depending on the age at implantation. Implantation is strongly recommended from the payers' perspective for children implanted before the age of 2 years.

Cited by 47 publications

References 10 publications

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

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

Cochlear Implant – State of the Art

Estimated net saving to society from cochlear implantation in infants: A preliminary analysis

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