Expanding Access: Cost-effectiveness of Cochlear Implantation and Deaf Education in Asia

Emmett SD 1 , Sudoko CK 2 , Tucci DL 1 , Gong W 3 , Saunders JE 4 , Global HEAR (Hearing Loss Evaluation, Advocacy, and Research) Collaborative: Show all authors , Akhtar N 5 , Bhutta MF 6 , Touch S 7 , Pradhananga RB 8 , Mukhtar N 9 , Martinez N 10 , Martinez FD 10 , Ramos H 10 , Kameswaran M 11 , Kumar RNS 11 , Soekin S 12 , Prepageran N 13

Affiliations 

  • 1 Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
  • 2 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  • 3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  • 4 Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
  • 5 Department of Otolaryngology-Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 6 Department of Ear, Nose, and Throat Surgery, Brighton and Sussex University Hospitals, Brighton, UK
  • 7 Children's Surgical Centre, Phnom Penh, Cambodia
  • 8 Department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical College, Kathmandu, Nepal
  • 9 Audiology Centre, Lahore, Pakistan
  • 10 University of Santo Tomas, Manila, Philippines
  • 11 Department of Implantation Otology, Madras ENT Research Foundation, Chennai, India
  • 12 Proklamasi ENT-HNS Institute, Jakarta, Indonesia
  • 13 Department of Otolaryngology-Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia
Otolaryngol Head Neck Surg, 2019 10;161(4):672-682.
PMID: 31210566 DOI: 10.1177/0194599819849917

Abstract

OBJECTIVE: To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia.

STUDY DESIGN: Cost-effectiveness analysis.

SETTING: Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study.

SUBJECTS AND METHODS: Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3.

RESULTS: Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)-the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39).

CONCLUSION: Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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