Cost‐effectiveness of pediatric bilateral cochlear implantation in Spain

Pérez-Martín, Jorge; Artaso, Miguel A.; Díez, F. J.

doi:10.1002/lary.26765

Cited by 17 publications

(11 citation statements)

References 30 publications

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“…As the clinical pathways for children receiving bilateral cochlear implants and bimodal hearing are the same for pre-surgery assessment for the second cochlear implant in both simultaneous and sequential bilateral cochlear implants, and post-surgery switch-on, mapping, and habilitation, only incremental resource use and costs relative to bimodal hearing were included in the analyses. This is similar to the approach by Martin et al (2017) which compared bilateral cochlear implantation with unilateral cochlear implantation [41]. Local cochlear implant experts indicated that compared to children receiving a single cochlear implant in bimodal hearing, children receiving simultaneous bilateral cochlear implantation will undergo a longer surgery procedure, with the same the intensity of follow-up reviews, mapping, and habilitation sessions.…”

Section: Methodssupporting

confidence: 53%

Cost-effectiveness analysis of bilateral cochlear implants for children with severe-to-profound sensorineural hearing loss in both ears in Singapore

Cheng

Soon

et al. 2019

PLoS ONE

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A cochlear implant is a small electronic device that provides a sense of sound for the user, which can be used unilaterally or bilaterally. Although there is advocacy for the benefits of binaural hearing, the high cost of cochlear implant raises the question of whether its additional benefits over the use of an acoustic hearing aid in the contralateral ear outweigh its costs. This cost-effectiveness analysis aimed to separately assess the cost-effectiveness of simultaneous and sequential bilateral cochlear implantations compared to bimodal hearing (use of unilateral cochlear implant combined with an acoustic hearing aid in the contralateral ear) in children with severe-to-profound sensorineural hearing loss in both ears from the Singapore healthcare payer perspective. Incremental quality-adjusted life year (QALYs) gained and costs associated with bilateral cochlear implants over the lifetime horizon were estimated based on a four-state Markov model. The analysis results showed that, at the 2017 mean cost, compared to bimodal hearing, patients receiving bilateral cochlear implants experienced more QALYs but incurred higher costs, resulting in an incremental cost-effectiveness ratio (ICER) of USD$60,607 per QALY gained for simultaneous bilateral cochlear implantation, and USD$81,782 per QALY gained for sequential bilateral cochlear implantation. The cost-effectiveness of bilateral cochlear implants is most sensitive to utility gain associated with second cochlear implant, and cost of bilateral cochlear implants. ICERs increased when the utility gain from bilateral cochlear implants decreased; ICERs exceeded USD$120,000 per QALY gained when the utility gain was halved from 0.03 to 0.015 in both simultaneous and sequential bilateral cochlear implantations. The choice of incremental utility gain associated with the second cochlear implant is an area of considerable uncertainty.

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Section: Methodssupporting

confidence: 53%

Cost-effectiveness analysis of bilateral cochlear implants for children with severe-to-profound sensorineural hearing loss in both ears in Singapore

Cheng

Soon

et al. 2019

PLoS ONE

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“…Although its clinical significance currently appears to be minimal, long-term findings in the timeframe of decades have yet to be reported. Data from adult studies suggests that following implant surgery, otolithic organs and canal function can be compromised, leading to potential clinical manifestations such as post-operative imbalance, vertigo, and falls [1, 4, 7]. This is especially concerning for children who are more commonly undergoing bilateral implantation, raising the theoretical concern of bilateral vestibular dysfunction in the long term following surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been recent efforts aimed at further characterizing the potential side effects of cochlear implantation in children, specifically with respect to resultant vestibular dysfunction. There has been a growing trend towards bilateral simultaneous implantation in children due to recent studies showing an increased ability to preserve normal cortical preference and development, improved sound localization contributing to enhanced preverbal communication and language development, and greater cost-effectiveness [1, 4–6]. The impact that bilateral implantation has on vestibular and balance function in children has been studied but methodologies and results are variable, making it difficult to draw general conclusions from this research.…”

Section: Introductionmentioning

confidence: 99%

Subjective and objective vestibular changes that occur following paediatric cochlear implantation: Systematic review and meta-analysis

Yong

Young

Lea

et al. 2019

Journal of Otolaryngology - Head & Neck Surgery

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Objective Cochlear implantation can result in post-operative vestibular dysfunction of unknown clinical significance. The objective of this study was to characterize the presence, magnitude, and clinical significance of vestibular dysfunction that occurs after pediatric cochlear implantation. Data sources The databases Embase, Medline (OvidSP), and PubMed were used. Only articles published in English were included. Grey literature and unpublished sources were also reviewed. Study selection Articles published from 1980 until the present which documented pre-operative and post-operative vestibular testing on children under the age of 18 were used. Data extraction Parameters that were assessed included number of patients, pre- and post-operative vestibular-evoked myogenic potentials (VEMPs), head impulse testing (HIT), calorics, and posturography, timing of pre- and post-operative testing, symptomatology, and other demographic data such as etiology of the hearing loss. Data synthesis Ten articles were included. Relative risk values evaluating the effect of cochlear implantation on vestibular function were calculated for VEMPs and caloric testing due to the availability of published data. I 2 values were calculated and 95% confidence intervals were reported. Separate analyses were conducted for each individual study and a pooled analysis was conducted to yield an overall relative risk. Assessment on risk of bias in individual studies and overall was performed. Conclusion Pediatric cochlear implantation is associated with a statistically significant decrease in VEMP responses post-operatively (RR 1.8, p < 0.001, I 2 91.86, 95%CI 1.57–2.02). Similar results are not seen in caloric testing. Insufficient data is available for analysis of HIT and posturography. Further studies are necessary to determine the effect of cochlear implantation on objective vestibular measures post-operatively and whether any changes seen are clinically relevant in this population.

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“…For example, in the case of cochlear implants, there is the upfront cost of the device and the surgery. 17 These costs should be accounted for separately, excluding them in any within-cycle correction, as explained by Elbasha and Chhatwal. 9…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Markov Models with Discontinuities

Pérez-Martín

Bermejo²,

Díez

2019

Med Decis Making

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Background. Several methods, such as the half-cycle correction and the life-table method, were developed to attenuate the error introduced in Markov models by the discretization of time. Elbasha and Chhatwal have proposed alternative “corrections” based on numerical integration techniques. They present an example whose results suggest that the trapezoidal rule, which is equivalent to the half-cycle correction, is not as accurate as Simpson’s 1/3 and 3/8 rules. However, they did not take into consideration the impact of discontinuities. Objective. To propose a method for evaluating Markov models with discontinuities. Design. Applying the trapezoidal rule, we derive a method that consists of adjusting the model by setting the cost at each point of discontinuity to the mean of the left and right limits of the cost function. We then take from the literature a model with a cycle length of 1 year and a discontinuity on the cost function and compare our method with other “corrections” using as the gold standard an equivalent model with a cycle length of 1 day. Results. As expected, for this model, the life-table method is more accurate than assuming that transitions occur at the beginning or the end of cycles. The application of numerical integration techniques without taking into account the discontinuity causes large errors. The model with averaged cost values yields very small errors, especially for the trapezoidal and the 1/3 Simpson rules. Conclusion. In the case of discontinuities, we recommend applying the trapezoidal rule on an averaged model because this method has a mathematical justification, and in our empirical evaluation, it was more accurate than the sophisticated 3/8 Simpson rule.

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Cost‐effectiveness of pediatric bilateral cochlear implantation in Spain

Abstract: 2C. Laryngoscope, 127:2866-2872, 2017.

Cited by 17 publications

References 30 publications

Cost-effectiveness analysis of bilateral cochlear implants for children with severe-to-profound sensorineural hearing loss in both ears in Singapore

Cost-effectiveness analysis of bilateral cochlear implants for children with severe-to-profound sensorineural hearing loss in both ears in Singapore

Subjective and objective vestibular changes that occur following paediatric cochlear implantation: Systematic review and meta-analysis

Evaluation of Markov Models with Discontinuities

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