How do costs compare between simultaneous cochlear implantation (SimCI) and sequential cochlear implantation (SeqCI) in adults if all bilaterally deaf patients undergo SeqCI vs. a theoretical model where SimCI is the standard?
In institutions where only SeqCI is allowed in adults, overall patient management may cost marginally more than if SimCI were practiced.
Explore this issue:November 2017
Background: Bilateral CI may be carried out either simultaneously (SimCI) or sequentially (SeqCI). The choice of which is performed varies among centers, with both clinical and financial factors coming into play.
Study design: Retrospective review and cost analysis of 370 patients who fulfilled the audiological criteria for bilateral implantation between 2005 and 2015, using costs from 29 patients between August 2015 and August 2016 for the analysis.
Setting: Otolaryngology Department, University of Arkansas for Medical Sciences, Little Rock
Synopsis: The overall additional initial implant stimulation series (IISS) cost for a patient undergoing SeqCI before entering routine follow-up was $4,732.55; the overall cost for a unilateral CI or SimCI was $2,568.00. The hospital and audiological costs of the 29 patients was calculated as $2,656,888.71. Adding the total audiological fee of $74,472 gives an overall total of $2,731,360.42. If 27.3% of these will progress to a second SeqCI, the additional cost of $750,811.04 will result in an overall total of $3,482,171.46. If all 29 patients underwent SimCI from the start, the projected cost would be $3,332,991.75 based on the cost for one patient ($112,362.75). The difference in costs between SeqCI and SimCI would be $149,179.67 (4.3%) in favor of simultaneous implantation. Expanding on this, unilateral cochlear implantation of 50 hypothetical patients would cost $4.71 million. If all 50 of these hypothetical patients underwent SimCI, it would cost $5.75 million, which is less than if 12 or more patients ultimately chose SeqCI. Limitations included a lack of quality-adjusted life year analysis and long-term costs, variations in individual patient charges, and a theoretical situation that may not be realized in practice.
Citation: Trinidade A, Page JC, Kennett SW, Cox MD, Dornhoffer JL. Simultaneous versus sequential bilateral cochlear implants in adults: cost analysis in a US setting. Laryngoscope. 2017;127:2615–2618.