Cost-Effectiveness of Pediatric Cochlear Implantation in Rural China

Abstract

Objectives:To evaluate the cost utility of cochlear implantation (CI) for severe to profound sensorineural hearing loss (SNHL) among children from rural settings in P.R. China (China).Research Design:A cost-utility analysis (CUA) was undertaken using data generated from a single-center substudy of the CochlearTM Pediatric Implanted Recipient Observational Study (Cochlear P-IROS). The data were projected over a 20-year time horizon using a decision tree model.Setting:The Chinese healthcare payer and patient perspectives were adopted.Intervention:Unilateral CI of children with a severe-to-profound SNHL compared with their preimplantation state of no treatment or amplification with hearing aids (“no CI” status).Main Outcome Measure/s:Incremental costs per quality adjusted life year (QALY) gained.Results:The mean total discounted cost of unilateral CI was CNY 252,506 (37,876 USD), compared with CNY 29,005 (4,351 USD) for the no CI status from the healthcare payer plus patient perspective. A total discounted benefit of 8.9 QALYs was estimated for CI recipients compared with 6.7 QALYs for the no CI status. From the healthcare payer plus patient perspective, incremental cost-effectiveness ratio (ICER) for unilateral CI compared with no CI was CNY 100,561 (15,084 USD) per QALY. The healthcare payer perspective yielded an ICER of CNY 40,929 (6,139 USD) per QALY. Both ICERs fell within one to three times China's gross domestic product per capita (GDP, 2011–2015), considered “cost-effective” by World Health Organization (WHO) standards.Conclusions:Treatment with unilateral CI is a cost-effective hearing solution for children with severe to profound SNHL in rural China. Increased access to mainstream education and greater opportunities for employment, are potential downstream benefits of CI that may yield further societal and economic benefits. CI may be considered favorably for broader inclusion in medical insurance schemes across China.

Parâmetros acústicos e perceptivoauditivos da voz de usuários de dispositivos auditivos

“…The CI users that participated in this study had a lower auditory threshold mean in the frequencies of 0.5, 1, and 2 kHz when compared with the HA group, agreeing with studies that Table 4. Comparison of the pure-tone means, by sex, of the fundamental frequency values (Hz), fundamental frequency standard deviation (Hz), jitter (%), shimmer (%), and harmonics-to-noise ratio (%), with their respective p-values, between the hearing aid (n = 8) and cochlear implant groups (n = 10), and male (n = 1) and female references (n = 1), obtained from the speech emissions with the Consensus Auditory- demonstrated that the technology of the CI to reestablish the auditory threshold is superior when compared with the HA (3) . Regarding the type of device, it was observed that the HA group stood out with its longtime use, in relation to the CI group.…”

“…As for people with bilateral severe to profound sensorineural HL, the acoustic gain provided by the HA may be limited, restricted to detecting only high-intensity sounds. As an alternative, the CI is an implantable electronic device that sends electric stimuli to the auditory nerve, enabling the person to receive sound stimuli and comprehend speech (3) .…”

Estimated Cost-effectiveness of Newborn Screening for Congenital Cytomegalovirus Infection in China Using a Markov Model

“…5,19,[24][25][26][27] The Markov models for children with hearing loss at birth consisted of 6 health states (eFigure 1 in the Supplement): 1 to profound hearing loss is the main indication of cochlear implant. 5,28 China's basic medical insurance package currently does not cover costs associated with cochlear implant. We assumed that 50% of children with S/P hearing loss received a cochlear implant based on expert consultation and literature review.…”

“…These costs were estimated based on a cost-effectiveness analysis on pediatric cochlear implant in China. 28…”

A parsimonious approach for screening moderate-to-profound hearing loss in a community-dwelling geriatric population based on a decision tree analysis

“…Specifically in the hearing science field, this technique has been used to seek the optimal suprathreshold test battery to classify auditory profiles towards effective hearing loss compensations [31]. More frequent applications of a decision tree analysis were evaluating whether a medical and audiological practice is cost-effective, for example, implanting cochlear prosthesis [32], the pursuit of magnetic resonance imaging (MRI) with or without contrast in the workup of undifferentiated asymmetrical sensorineural hearing loss [33], and universal or selective hearing screening on newborns [34, 35]. Some sophisticated machine learning technologies (e.g., neural network multilayer perceptron, support vector machine, random forest, adaptive boosting) have also been used in the hearing healthcare area, for instance, predicting postoperative monosyllabic word recognition performance in adult cochlear implant recipients [36] or predicting noise-induced hearing loss of manufacture workers based on demographic information and working acoustical environments [37, 38].…”