Do the costs and benefits of cochlear implantation differ between infants and older children?
Background: While many studies show more rapid auditory and cognitive development in early cochlear implantation, other studies report little difference in outcomes in a small sample of children, some implanted before 12 months of age and others implanted later. Additionally, the development and diffusion of cochlear implants have been limited mainly for economic reasons.
Study design: Retrospective cohort study.
Setting: ENT Department, University of Verona, Italy; House Research Institute, Los Angeles.
Synopsis: Sixty-eight children ages 2 to 83 months were fitted with the same model cochlear implant and followed up at least to the chronological age of 10 years. Pre-implantation audiological assessments were provided for all children, as were CT and MRI scans. Postoperatively, all children were evaluated using the Peabody Picture Vocabulary Test-Revised (PPVT-R) to test their receptive language level. Data for direct and indirect costs were obtained from parent questionnaires; existing national healthcare and educational systems; and Verona ENT Department databases and retail prices for materials used. Implantation in infants was associated with lower total costs for the first 10 years of life.
Decreasing the age of implantation from 6 years to 24 to 35 months achieved a reduction of around 3 percent in the total cost to society. The net savings to society ranged from around 21,000 Euros in the two younger classes to more than 35,000 Euros when comparing infants with children in the oldest group. The costs for education, in particular for the family, increase dramatically for children implanted at older ages. Additional costs associated with later implantation include hearing aids and their maintenance, speech therapy, days off work and travel expenses for parents. When implantation was delayed, family costs played an important role in the increase in expenses. PPVT-R scores were best in the youngest groups implanted.
Bottom line: Cochlear implants for patients younger than 1 year afford significantly improved performance and a net savings to society.
Citation: Colletti L, Mandalà M, Shannon RV, et al. Estimated net saving to society from cochlear implantation in infants: a preliminary analysis. Laryngoscope. 2011;121(11):2455-2460.
—Reviewed by Sue Pondrom