Cost-benefit Analysis of Cochlear Implants: A Societal Perspective

Ear and Hearing, vol. 42, pp. 1338–1350

Abstract

OBJECTIVES: While the costs and outcomes of cochlear implantation (CI) have been widely assessed, most of these analyses were solely performed from the perspective of healthcare costs. This study assesses the costs and benefits of CI in the Netherlands from a broader societal perspective, including health outcomes, healthcare cost, educational cost, and productivity losses and gains. DESIGN: The cost and benefits of CI were analyzed in this cost-benefit analysis, in which a monetary value is put on both the resources needed and the outcomes of CI. The costs and benefits were analyzed by prototypical instances of three groups, representing the majority of cochlear implant patients: prelingually deaf children implanted at the age of 1, adults with progressive profound hearing loss implanted at the age of 40 and seniors implanted at the age of 70 with progressive profound hearing loss. Costs and benefits were estimated over the expected lifetimes of the members of each group, using a Markov state transition model. Model parameters and assumptions were based on published literature. Probabilistic and one-way sensitivity analyses were performed. RESULTS: In all three patient groups, the total benefits of CI exceeded the total cost, leading to a net benefit of CI. Prelingually deaf children with a bilateral CI had a lifetime positive outcome net benefit of €433,000. Adults and seniors with progressive profound hearing loss and a unilateral CI had a total net benefit of €275,000 and €76,000, respectively. These results ensue from health outcomes expressed in monetary terms, reduced educational cost, and increased productivity. CONCLUSIONS: Based on estimates from modeling, the increased healthcare costs due to CI were more than compensated by the value of the health benefits and by savings in educational and productivity costs. In particular, for children and working adults, the societal benefit was positive even without taking health benefits into account. Therefore, CI generates an advantage for both patients and society.

Authors 6

1. Olaf M. Neve Aachen Department of Otorhinolaryngology and Head & Neck Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands

2. Jenneke A. Boerman Aachen Finance Department

   Leiden University Medical Center

   Affiliation as printed

   Finance Department, Leiden University Medical Center, Leiden, the Netherlands

3. Wilbert B. van den Hout Aachen Medical Decision Making Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

4. Jeroen Johannes Briaire Aachen Department of Otorhinolaryngology and Head & Neck Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands

5. Peter Paul G. van Benthem Aachen Department of Otorhinolaryngology and Head & Neck Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands

6. Johan H. M. Frijns corresponding Aachen Department of Otorhinolaryngology and Head & Neck Surgery Leiden Institute for Brain and Cognition

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands

   Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands