Age-dependent cost-utility of pediatric cochlear implantation

Yevgeniy R. Semenov, Susan T. Yeh, Meena Seshamani, Nae Yuh Wang, Emily A. Tobey, Laurie S. Eisenberg, Alexandra Quittner, Kevin D. Frick, John K. Niparko

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objectives: Cochlear implantation (CI) has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence of the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation-a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the present study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost utility of pediatric CI by age at intervention will be analyzed. Design: Prospective, longitudinal assessment of health utility and educational placement outcomes in 175 children recruited from six U.S. centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent CI before 5 years of age, and had up to 6 years of postimplant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratifed by preoperative, operative, and postoperative expenditures. Incremental costs and benefits of implantation were compared among the three age groups and relative to a nonimplantation baseline. Results: Children implanted at <18 months of age gained an average of 10.7 quality-adjusted life years (QALYs) over their projected lifetime as compared with 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different among the three age groups. In addition, mean lifetime costs of implantation were similar among the three groups, at approximately $2000/child/year (77.5-year life expectancy), yielding costs of $14, 996, $17, 849, and $19, 173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared with 57 and 63% for the middle and oldest groups, respectively (p < 0.05) after 6 years of follow-up. After incorporating lifetime educational cost savings, CI led to net societal savings of $31, 252, $10, 217, and $6, 680 for the youngest, middle, and oldest groups at CI, respectively, over the child's projected lifetime. Conclusions: Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with CI was associated with greater and longer quality-of-life improvements, similar direct costs of implantation, and economically valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to CI at older ages.

Original languageEnglish
Pages (from-to)402-412
Number of pages11
JournalEar and Hearing
Volume34
Issue number4
DOIs
StatePublished - Jul 1 2013

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Cochlear Implantation
Pediatrics
Costs and Cost Analysis
Age Groups
Sensorineural Hearing Loss
Quality-Adjusted Life Years
Cost Savings
Health Expenditures
Quality Improvement
Life Expectancy
Cost-Benefit Analysis
Parents
Economics
Quality of Life
Incidence
Health

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Speech and Hearing

Cite this

Semenov, Y. R., Yeh, S. T., Seshamani, M., Wang, N. Y., Tobey, E. A., Eisenberg, L. S., ... Niparko, J. K. (2013). Age-dependent cost-utility of pediatric cochlear implantation. Ear and Hearing, 34(4), 402-412. https://doi.org/10.1097/AUD.0b013e3182772c66

Age-dependent cost-utility of pediatric cochlear implantation. / Semenov, Yevgeniy R.; Yeh, Susan T.; Seshamani, Meena; Wang, Nae Yuh; Tobey, Emily A.; Eisenberg, Laurie S.; Quittner, Alexandra; Frick, Kevin D.; Niparko, John K.

In: Ear and Hearing, Vol. 34, No. 4, 01.07.2013, p. 402-412.

Research output: Contribution to journalArticle

Semenov, YR, Yeh, ST, Seshamani, M, Wang, NY, Tobey, EA, Eisenberg, LS, Quittner, A, Frick, KD & Niparko, JK 2013, 'Age-dependent cost-utility of pediatric cochlear implantation', Ear and Hearing, vol. 34, no. 4, pp. 402-412. https://doi.org/10.1097/AUD.0b013e3182772c66
Semenov YR, Yeh ST, Seshamani M, Wang NY, Tobey EA, Eisenberg LS et al. Age-dependent cost-utility of pediatric cochlear implantation. Ear and Hearing. 2013 Jul 1;34(4):402-412. https://doi.org/10.1097/AUD.0b013e3182772c66
Semenov, Yevgeniy R. ; Yeh, Susan T. ; Seshamani, Meena ; Wang, Nae Yuh ; Tobey, Emily A. ; Eisenberg, Laurie S. ; Quittner, Alexandra ; Frick, Kevin D. ; Niparko, John K. / Age-dependent cost-utility of pediatric cochlear implantation. In: Ear and Hearing. 2013 ; Vol. 34, No. 4. pp. 402-412.
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abstract = "Objectives: Cochlear implantation (CI) has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence of the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation-a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the present study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost utility of pediatric CI by age at intervention will be analyzed. Design: Prospective, longitudinal assessment of health utility and educational placement outcomes in 175 children recruited from six U.S. centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent CI before 5 years of age, and had up to 6 years of postimplant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratifed by preoperative, operative, and postoperative expenditures. Incremental costs and benefits of implantation were compared among the three age groups and relative to a nonimplantation baseline. Results: Children implanted at <18 months of age gained an average of 10.7 quality-adjusted life years (QALYs) over their projected lifetime as compared with 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different among the three age groups. In addition, mean lifetime costs of implantation were similar among the three groups, at approximately $2000/child/year (77.5-year life expectancy), yielding costs of $14, 996, $17, 849, and $19, 173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81{\%} as compared with 57 and 63{\%} for the middle and oldest groups, respectively (p < 0.05) after 6 years of follow-up. After incorporating lifetime educational cost savings, CI led to net societal savings of $31, 252, $10, 217, and $6, 680 for the youngest, middle, and oldest groups at CI, respectively, over the child's projected lifetime. Conclusions: Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with CI was associated with greater and longer quality-of-life improvements, similar direct costs of implantation, and economically valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to CI at older ages.",
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AU - Semenov, Yevgeniy R.

AU - Yeh, Susan T.

AU - Seshamani, Meena

AU - Wang, Nae Yuh

AU - Tobey, Emily A.

AU - Eisenberg, Laurie S.

AU - Quittner, Alexandra

AU - Frick, Kevin D.

AU - Niparko, John K.

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N2 - Objectives: Cochlear implantation (CI) has become the mainstay of treatment for children with severe-to-profound sensorineural hearing loss (SNHL). Yet, despite mounting evidence of the clinical benefits of early implantation, little data are available on the long-term societal benefits and comparative effectiveness of this procedure across various ages of implantation-a choice parameter for parents and clinicians with high prognostic value for clinical outcome. As such, the aim of the present study is to evaluate a model of the consequences of the timing of this intervention from a societal economic perspective. Average cost utility of pediatric CI by age at intervention will be analyzed. Design: Prospective, longitudinal assessment of health utility and educational placement outcomes in 175 children recruited from six U.S. centers between November 2002 and December 2004, who had severe-to-profound SNHL onset within 1 year of age, underwent CI before 5 years of age, and had up to 6 years of postimplant follow-up that ended in November 2008 to December 2011. Costs of care were collected retrospectively and stratifed by preoperative, operative, and postoperative expenditures. Incremental costs and benefits of implantation were compared among the three age groups and relative to a nonimplantation baseline. Results: Children implanted at <18 months of age gained an average of 10.7 quality-adjusted life years (QALYs) over their projected lifetime as compared with 9.0 and 8.4 QALYs for those implanted between 18 and 36 months and at >36 months of age, respectively. Medical and surgical complication rates were not significantly different among the three age groups. In addition, mean lifetime costs of implantation were similar among the three groups, at approximately $2000/child/year (77.5-year life expectancy), yielding costs of $14, 996, $17, 849, and $19, 173 per QALY for the youngest, middle, and oldest implant age groups, respectively. Full mainstream classroom integration rate was significantly higher in the youngest group at 81% as compared with 57 and 63% for the middle and oldest groups, respectively (p < 0.05) after 6 years of follow-up. After incorporating lifetime educational cost savings, CI led to net societal savings of $31, 252, $10, 217, and $6, 680 for the youngest, middle, and oldest groups at CI, respectively, over the child's projected lifetime. Conclusions: Even without considering improvements in lifetime earnings, the overall cost-utility results indicate highly favorable ratios. Early (<18 months) intervention with CI was associated with greater and longer quality-of-life improvements, similar direct costs of implantation, and economically valuable improved classroom placement, without a greater incidence of medical and surgical complications when compared to CI at older ages.

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