Cost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua

Abstract

Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.

Measuring Success

“…Although most children are able to reach academic and employment levels that are comparable to their normal hearing peers, these outcomes are influenced by the age of implantation, parental education, and socioeconomic factors (31). The potential cost effectiveness of cochlear implants has also been confirmed in Nicaragua and many countries in Sub-Saharan Africa using DALY methodology in two recent studies (32,33).…”

Deaf children need language, not (just) speech

“…Children with severe to profound bilateral deafness are increasingly likely to receive cochlear implants (CIs) in infancy/toddlerhood. Already considered the standard of care in most advanced economies (Sorkin, 2013), cochlear implantation is beginning to expand to emerging economies as well (Adoga, Nwaorgu, Anthis, & Green, 2014;Emmett et al, 2015;Harris, M. S. & Dodson, 2017;Mulwafu, Strachan, Bartlett, & Caron, 2017;Saunders et al, 2015). Recent, large-scale studies of spoken language outcomes in pediatric CI recipients have been conducted in Australia and the United States.…”

Make Quality Hearing Health Information Available to All

“…Twenty studies provided information on the costs of hearing loss among children up to 14 years of age. However, the studies tended to focus specifically on the costs associated with children who received various forms of implants rather than all children who experienced hearing loss (Cheng et al, 2000;Schulze-Gattermann et al, 2002;Barton et al, 2006b;Semenov et al, 2013;Saunders et al, 2015). They also tended to provide incidence-based lifetime cost estimates rather than annual costs to health-care systems (Keren et al, 2002;Honeycutt et al, 2004).…”

“…Some of these studies were excluded from consideration for this global costing model because they focused only on narrow segments of the population, e.g. children with severe to profound hearing loss (Cheng et al, 2000;Mohr et al, 2000;Schulze-Gattermann et al 2002;Saunders et al, 2015), or on a very small number of cases (Francis et al, 1999) or because they had been superseded by more recent estimates (O`Neill et al, 2001). A study from China reported the estimated mean costs of special education over nine years for children who had not been subject to neonatal screening or treated subsequently for permanent congenital and early-onset hearing loss were $42 300, or $4700 per annum (Huang et al, 2012).…”