Technology improves quality of life and saves $50,000 + over child's lifetime
Researchers at Johns Hopkins report that cochlear implants, electronic devices surgically implanted behind the ear to bring sound to profoundly deaf people, not only improve children's quality of life, but also are highly cost-effective, with an expected lifetime savings of $53,198. The study, published in the Aug. 16 issue of the Journal of the American Medical Association (JAMA), is the first to evaluate the cost of quality-of-life improvements in pediatric cochlear implant patients using U.S. cost data, the authors say.
According to Neil R. Powe, M.D., M.P.H., M.B.A., professor of medicine, epidemiology and health policy and management at Hopkins and one of the study's co-authors, the findings linking quality of life and cost-savings are unusual. "Most new interventions in medical care that improve health also raise the cost. In this case, we've found that when you include all the associated costs and consequences, the implant actually saves society money in the long term," he says. The cost-benefit comes in the form of fewer demands on special education and greater wage-earning opportunities of implant recipients.
Powe and his colleagues conducted a cost-utility analysis, measuring a cochlear implant's effect on quality of life against the costs of the device. They surveyed parents of children with implants, all patients at The Listening Center at Johns Hopkins. The children averaged 7.4 years of age with 1.9 years of implant use. Parents rated their children's health "now," "immediately before" and "1-year before" the implant, through a standard series of methods.
The team also estimated the costs directly associated with the implant (device, surgery, rehabilitation, maintenance, etc.) and those indirectly affected by the device (time off work, travel, and change in educational costs, etc.), as well as cost savings.
In 1992, cochlear implants were approved for use in profoundly deaf children who fail to benefit from conventional hearing aids. Since its entrance to the market, cochlear implant technology has been one of many new devices questioned by health insurers for reimbursement.
"Providing an option to profound deafness is neither easy nor cheap, and for many years we've ignored the financial aspects of this treatment, thinking that for young children, cost should not be an issue," says senior author John K. Niparko, M.D., professor of otolaryngology head and neck surgery and director of the Listening Center. "However, rising health care costs have led to pressures that discourage technologies such as the cochlear implant, and many health care plans cite 'no timely cost-effectiveness data' as a barrier to reimbursement for the device. This study, by weighing costs of both the device and the benefit provided to a large group of children, provides the beginning of evidence that from a societal perspective, cochlear implantation in children is highly cost-effective." Niparko hopes that these findings will encourage similar research on a national level.
Earlier research had shown the device was cost-effective in adults, and it was speculated that children, because of their prolonged use of the device, stood to reap a greater cost-benefit over a longer period of time. Previous pediatric cochlear implant studies either considered quality-of-life benefits in a hypothetical way or used data from adults and were performed in England or Australia.
Setting aside the special education and greater wage-earning opportunities of implant recipients, the cost-utility of pediatric cochlear implantation ($9,029 per quality adjusted life year [QALY]) compares favorably (less dollars paid for the benefit) to many other implantable technologies, including the implantable defibrillator ($34,846 per QALY), knee replacement ($59,292 per QALY), and adult cochlear implantation ($11,125 per QALY).
The principal investigator of the study is Andre Cheng, M.D., Ph.D. In addition to Powe and Niparko, co-investigators include: Haya Rubin, M.D., Ph.D., Nancy Mellon, M.S., and Howard Francis, M.D. Their work was supported in part by a training grant from the National Institute on Deafness and Other Communication Disorders, National Institutes of Health, and grants from the Deafness Research Foundation, the Advisory Board Foundation and the Sidgmore Family Foundation.
August 11, 2000
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Journal
JAMA