Barton Garry R, Stacey Paula C, Fortnum Heather M, Summerfield A Quentin
MRC Institute of Hearing Research, University Park, Nottingham, United Kingdom.
Ear Hear. 2006 Apr;27(2):187-207. doi: 10.1097/01.aud.0000202348.77016.1f.
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.
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.
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.
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.
本研究的目的是评估人工耳蜗植入对英国听力受损儿童义务教育成本的影响。
在一项横断面调查中，要求教师报告有代表性的听力受损儿童样本的学校安置情况及所提供的支持量。学校安置成本从已发表的资料中获取。支持成本通过对11项特殊教育服务的调查计算得出。每个儿童的年度教育成本（按2001/2002年水平的欧元计算）通过将安置成本和支持成本相加得出。线性回归分析在控制其他九个变量的同时，计算年度教育成本与是否拥有植入物之间的关联：平均（未助听、术前）听力水平（AHL）、听力障碍发病年龄、年龄、性别、其他残疾数量、父母职业技能水平、种族、父母听力状况和学业成绩。
共收到2241名儿童的数据，其中383名儿童植入了人工耳蜗。年度教育成本均值从中度听力受损儿童的15745欧元到未植入人工耳蜗的重度听力受损儿童的30071欧元不等，植入人工耳蜗的儿童为28058欧元。年度教育成本较低与更有利的AHL、听力障碍发病较晚、女性、年龄较小、其他残疾较少以及学业成绩较高相关。当控制这些变量时，对于AHL超过111dB的儿童子集，植入人工耳蜗的儿童平均成本低于未植入的儿童。在植入人工耳蜗儿童的平均AHL（115dB）水平下，植入与年度教育成本降低3105欧元（95%置信区间，1105欧元至5106欧元）相关。
小儿人工耳蜗植入足够有效，足以影响教育部门的资源分配决策。植入的医疗服务成本部分被教育成本的节省所抵消。这些节省不会损害学业成绩。
