title: Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada.
abstract: Objectives To investigate provincial cochlear implantation (CI) annual volume and cost trends. Study Design Database analysis. Setting National surgical volume and cost database. Subjects and Methods Aggregate-level provincial CI volumes and cost data for adult and pediatric CI surgery from 2005 to 2014 were obtained from the Canadian Institute for Health Information. Population-level aging forecast estimates were obtained from the Ontario Ministry of Finance and Statistics Canada. Linear fit, analysis of variance, and Tukey's analyses were utilized to compare variances and means. Results The national volume of annual CI procedures is forecasted to increase by <30 per year ( R2= 0.88). Ontario has the highest mean annual CI volume (282; 95% confidence interval, 258-308), followed by Alberta (92.0; 95% confidence interval, 66.3-118), which are significantly higher than all other provinces ( P < .05 for each). Ontario's annual CI procedure volume is forecasted to increase by <11 per year ( R2= 0.62). Newfoundland and Nova Scotia have the highest CI procedures per 100,000 residents as compared with all other provinces ( P < .05). Alberta, Newfoundland, and Manitoba have the highest estimated implantation cost of all provinces ( P < .05). Conclusions Historical trends of CI forecast modest national volume growth. Potential bottlenecks include provincial funding and access to surgical expertise. The proportion of older adult patients who may benefit from a CI will rise, and there may be insufficient capacity to meet this need. Delayed access to CI for pediatric patients is also a concern, given recent reports of long wait times for CI surgery.
authors.affiliation: 1 Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Crowson
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Canada.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Chen
authors.affiliation: 1 Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Debara
authors.initials: D
authors.lastname: Tucci
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D019929:Cochlear Implantation / Q000191:economics* / Q000706:statistics & numerical data*; D003054:Cochlear Implants / Q000191:economics* / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D034381:Hearing Loss / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies
keywords: cochlear implantation; geographic variation; hearing loss