Trends in Educational Placement and Cost-Benefit Considerations in Children With Cochlear Implants

TLDR

The study investigates how cochlear implantation affects educational resource use and cost–benefit trends in profoundly hearing‑impaired children. Researchers conducted a retrospective cost‑benefit analysis of 35 implanted children and 10 non‑implanted peers, comparing systematic auditory skill development at Johns Hopkins’ Listening Center with standard amplification and educational management. Longer cochlear‑implant experience is associated with higher mainstream classroom placement, reduced special‑education hours, and cost savings of $30,000–$200,000, indicating a favorable educational cost‑benefit.

Abstract

To study the effect of cochlear implantation on the use of educational resources by profoundly hearing-impaired children and to determine trends in educational cost vs benefit.Retrospective study and cost-benefit analysis.Outpatient pediatric cochlear implant program in an academic institution (The Listening Center at Johns Hopkins University School of Medicine, Baltimore, Md), in collaboration with public schools in Maryland and surrounding states.School-aged children with profound prelingual hearing impairment without other clearly defined disabilities. Thirty-five children with multiple-channel cochlear prostheses and a comparison group of 10 children without implants from 'total communication' programs in the Maryland public school system.Multiple-channel cochlear implantation and at least 1 year of a systematic auditory skill development program at the Listening Center, compared with standard educational management of children with conventional amplification.Classroom placement and number of hours of special educational support used.A correlation was observed between the length of cochlear implant experience and the rate of full-time placement in mainstream classrooms (r = 0.10; P= .04). There was also a negative correlation between the length of implant experience and the number of hours of special educational support used by fully mainstreamed children (Pearson product moment correlation = -0.10; P = .03). Children with greater than 2 years of implant experience were mainstreamed at twice the rate or more of age-matched children with profound hearing loss who did not have implants. They were also placed less frequently in self-contained classrooms and used fewer hours of special education support. A cost-benefit analysis based on conservative estimates of educational expenses from kindergarten to 12th grade shows a cost savings of cochlear implantation and appropriate auditory (re)habilitation that ranges from $30000 to $200000.Cochlear implantation accompanied by aural (re)habilitation increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services. The cost savings that results from a decrease in the use of support services indicates an educational cost benefit of cochlear implant (re)habilitation for many children.