title: Age-dependent cost-utility of pediatric cochlear implantation.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 stratified 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.
authors.affiliation: Department of Otolaryngology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Yevgeniy R
authors.initials: YR
authors.lastname: Semenov
authors.forename: Susan T
authors.initials: ST
authors.lastname: Yeh
authors.forename: Meena
authors.initials: M
authors.lastname: Seshamani
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Emily A
authors.initials: EA
authors.lastname: Tobey
authors.forename: Laurie S
authors.initials: LS
authors.lastname: Eisenberg
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Quittner
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: John K
authors.initials: JK
authors.lastname: Niparko
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D060345:Education of Persons with Hearing Disabilities / Q000191:economics; D004522:Educational Status; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006319:Hearing Loss, Sensorineural / Q000191:economics / Q000601:surgery*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
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