Health-service costs of pediatric cochlear implantation: multi-center analysis

Objective: Pediatric cochlear implantation (CI) entails surgery followed by lifetime maintenance, and hence incurs both initial and ongoing costs. Previous assessments of these costs were either undertaken early in the evolution of services, or were based on single hospitals, or estimated costs largely from hospital charges. The aim was to overcome these limitations by conducting a multi-center evaluation of the costs of providing unilateral CI to children in the United Kingdom (UK). Methods: Annual numbers of implantations in all UK pediatric CI programs were monitored prospectively from 1991. Resource use was measured in 12 programs in 1998/1999 and retrospectively back to the year of inception of each program. The profile of outpatient and outreach visits was assessed in the 12 programs. Together these variables were used to estimate health-service costs for four phases of management: pre-operative assessment, implantation, tuning, and subsequent maintenance, using economic micro-costing methods. Costs were subsequently estimated for all children implanted in 1998/1999 (N = 199) and were aggregated over 1, 15, and 73 years following implantation. To assess the robustness of cost estimates, parameter values were varied over plausible ranges and costs re-estimated. Total UK health-service costs were also estimated. All costs are presented in euros (E1 = US$0.98 = pound0.65, 1st July 2002), inflated to 2000/2001 financial-year levels, and discounted at 6% per annum. Results: Per-child average costs were E42972 (1-year), E73763 (15-years), and E95034 (73-years). Cost estimates were not overly sensitive to the value of any one cost component nor to the relative cost of outpatient and outreach visits. When these parameters were varied, costs ranged between E30000 and E47000 (1-year), E61 000 and E83 000 (15-years), and E82 000 and E108 000 (73-years). The total UK health-service cost of unilateral pediatric CI was estimated to be E14 million in 2000/2001 and is predicted to rise to 23 million in 2015/2016, if the present model of service-delivery continues. The cost of maintaining implanted children was estimated to account for 22% of the total in 2000/2001 and is predicted to rise to 63% by 2015/2016. Conclusions: Ongoing costs of maintaining implanted children and their implant systems are significant and should be factored into resource-allocation decisions. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.