Cost-Utility Analysis of the Cochlear Implant in Children

TLDR

Barriers to cochlear implant use in profoundly deaf children include high device costs, difficulty assessing benefit, and a lack of comparative data. The study aimed to evaluate the quality‑of‑life and cost consequences of cochlear implantation in these children. A cost‑utility analysis was conducted using pre‑ and post‑implantation surveys from July 1998 to May 2000, with parents rating their child’s health state at multiple time points. The implant improved quality‑of‑life scores (VAS up 0.27, TTO up 0.22, HUI up 0.39) and cost‑effectiveness (direct cost $60,228 per QALY, $5,197–$9,029 per QALY depending on metric) while yielding net societal savings of $53,198 per child.

Abstract

ContextBarriers to the use of cochlear implants in children with profound deafness include device costs, difficulty assessing benefit, and lack of data to compare the implant with other medical interventions.ObjectiveTo determine the quality of life and cost consequences for deaf children who receive a cochlear implant.DesignCost-utility analysis using preintervention, postintervention, and cross-sectional surveys conducted from July 1998 to May 2000.SettingHearing clinic at a US academic medical center.ParticipantsParents of 78 profoundly deaf children (average age, 7.5 years) who received cochlear implants.Main Outcome MeasuresDirect and total cost to society per quality-adjusted life-year (QALY) using the time-trade-off (TTO), visual analog scale (VAS), and Health Utilities Index—Mark III (HUI), discounting costs and benefits 3% annually. Parents rated their child's health state at the time of the survey and immediately before and 1 year before implantation.ResultsRecipients had an average of 1.9 years of implant use. Mean VAS scores increased by 0.27, from 0.59 before implantation to 0.86 at survey. In a subset of participants, TTO scores increased by 0.22, from 0.75 to 0.97 (n = 40) and HUI scores increased by 0.39, from 0.25 to 0.64 (n = 22). Quality-of-life scores were no different 1 year before and immediately before implantation. Discounted direct costs were $60,228, yielding $9029 per QALY using the TTO, $7500 per QALY using the VAS, and $5197 per QALY using the HUI. Including indirect costs such as reduced educational expenses, the cochlear implant provided a savings of $53,198 per child.ConclusionsCochlear implants in profoundly deaf children have a positive effect on quality of life at reasonable direct costs and appear to result in a net savings to society.