Objectives: Cochlear implantation (CI) has become the
mainstay of treatment for children with severe-to-profound sensorineural
hearing loss (SNHL). Yet, despite mounting evidence of the clinical
benefits of early implantation, little data are available on the
long-term societal benefits and comparative effectiveness of this
procedure across various ages of implantation-a choice parameter for
parents and clinicians with high prognostic value for clinical outcome.
As such, the aim of the present study is to evaluate a model of the
consequences of the timing of this intervention from a societal economic
perspective. Average cost utility of pediatric CI by age at
intervention will be analyzed.
Design: Prospective, longitudinal assessment of health
utility and educational placement outcomes in 175 children recruited
from six U.S. centers between November 2002 and December 2004, who had
severe-to-profound SNHL onset within 1 year of age, underwent CI before 5
years of age, and had up to 6 years of postimplant follow-up that ended
in November 2008 to December 2011. Costs of care were collected
retrospectively and stratified by preoperative, operative, and
postoperative expenditures. Incremental costs and benefits of
implantation were compared among the three age groups and relative to a
nonimplantation baseline.
Results: Children implanted at <18 10.7="" 18="" 36="" 8.4="" 9.0="" age="" an="" and="" as="" at="" average="" between="" compared="" for="" gained="" implanted="" life="" lifetime="" months="" of="" over="" projected="" qalys="" quality-adjusted="" s="" their="" those="" with="" years="">36 months of age,
respectively. Medical and surgical complication rates were not
significantly different among the three age groups. In addition, mean
lifetime costs of implantation were similar among the three groups, at
approximately $2000/child/year (77.5-year life expectancy), yielding
costs of $14,996, $17,849, and $19,173 per QALY for the youngest,
middle, and oldest implant age groups, respectively. Full mainstream
classroom integration rate was significantly higher in the youngest
group at 81% as compared with 57 and 63% for the middle and oldest
groups, respectively (p < 0.05) after 6 years of follow-up. After
incorporating lifetime educational cost savings, CI led to net societal
savings of $31,252, $10,217, and $6,680 for the youngest, middle, and
oldest groups at CI, respectively, over the child's projected lifetime.
Conclusions: Even without considering improvements in
lifetime earnings, the overall cost-utility results indicate highly
favorable ratios. Early (<18 a="" ages.="" and="" associated="" at="" ci="" classroom="" compared="" complications="" costs="" direct="" economically="" greater="" implantation="" improved="" improvements="" incidence="" intervention="" longer="" medical="" months="" of="" older="" p="" placement="" quality-of-life="" similar="" surgical="" to="" valuable="" was="" when="" with="" without="">
(C) 2013 Lippincott Williams & Wilkins, Inc.
