Hearing-impaired children in the United Kingdom, II: Cochlear implantation and the cost of compulsory education.

OBJECTIVE

The objective of this study was to estimate the impact of cochlear implantation on the cost of compulsory education of hearing-impaired children in the United Kingdom.

STUDY DESIGN

In a cross-sectional survey, teachers were asked to report the school placement of, and amount of support provided to, a representative sample of hearing-impaired children. Costs of school placement were obtained from published sources. Costs of support were calculated from a survey of 11 special education services. The annual education cost (in euros at 2001/2002 levels) of each child was calculated by summing the placement and support costs. Linear regression analyses calculated the association between annual education cost and possession of an implant while controlling nine other variables: average (unaided, preoperative) hearing level (AHL), age at onset of hearing impairment, age, gender, the number of additional disabilities, parental occupational skill level, ethnicity, parental hearing status, and academic achievement.

RESULTS

Data were received for 2241 children, 383 of whom had cochlear implants. Mean annual education cost ranged from 15,745 euros for children with moderate hearing impairments to 30,071 euros for nonimplanted children with profound hearing impairments and was 28,058 euros for implanted children. A lower annual education cost was associated with a more favorable AHL, a later age at the onset of hearing impairment, female gender, a younger age, fewer additional disabilities, and a higher level of academic achievement. When these variables were controlled, costs were lower on average for implanted compared with nonimplanted children for the subset of children whose AHLs exceeded 111 dB. At the mean AHL of the implanted children (115 dB), implantation was associated with a reduction of 3105 euros (95% confidence interval, 1105 euros to 5106 euros) in annual education costs.

CONCLUSIONS

Pediatric cochlear implantation is sufficiently effective to influence resource-allocation decisions in the education sector. The health-service cost of implantation is partly offset by savings in the cost of education. These savings occur without detriment to academic achievements.