Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Finance Department, Leiden University Medical Center, Leiden, the Netherlands.
Ear Hear. 2021 Sep/Oct;42(5):1338-1350. doi: 10.1097/AUD.0000000000001021.
While the costs and outcomes of cochlear implantation (CI) have been widely assessed, most of these analyses were solely performed from the perspective of healthcare costs. This study assesses the costs and benefits of CI in the Netherlands from a broader societal perspective, including health outcomes, healthcare cost, educational cost, and productivity losses and gains.
The cost and benefits of CI were analyzed in this cost-benefit analysis, in which a monetary value is put on both the resources needed and the outcomes of CI. The costs and benefits were analyzed by prototypical instances of three groups, representing the majority of cochlear implant patients: prelingually deaf children implanted at the age of 1, adults with progressive profound hearing loss implanted at the age of 40 and seniors implanted at the age of 70 with progressive profound hearing loss. Costs and benefits were estimated over the expected lifetimes of the members of each group, using a Markov state transition model. Model parameters and assumptions were based on published literature. Probabilistic and one-way sensitivity analyses were performed.
In all three patient groups, the total benefits of CI exceeded the total cost, leading to a net benefit of CI. Prelingually deaf children with a bilateral CI had a lifetime positive outcome net benefit of €433,000. Adults and seniors with progressive profound hearing loss and a unilateral CI had a total net benefit of €275,000 and €76,000, respectively. These results ensue from health outcomes expressed in monetary terms, reduced educational cost, and increased productivity.
Based on estimates from modeling, the increased healthcare costs due to CI were more than compensated by the value of the health benefits and by savings in educational and productivity costs. In particular, for children and working adults, the societal benefit was positive even without taking health benefits into account. Therefore, CI generates an advantage for both patients and society.
尽管人工耳蜗植入（CI）的成本和结果已经得到了广泛的评估，但这些分析大多仅从医疗保健成本的角度进行。本研究从更广泛的社会视角评估荷兰 CI 的成本和效益，包括健康结果、医疗保健成本、教育成本以及生产力的损失和收益。
本成本效益分析对 CI 的成本和效益进行了分析，其中对 CI 所需的资源和结果都赋予了货币价值。通过代表大多数耳蜗植入患者的三组典型实例来分析成本和效益：1 岁时接受人工耳蜗植入的语前聋儿童、40 岁时接受人工耳蜗植入的渐进性重度听力损失成人以及 70 岁时接受人工耳蜗植入的渐进性重度听力损失老年人。使用马尔可夫状态转移模型估算每个组别的成员的预期寿命内的成本和效益。模型参数和假设基于已发表的文献。进行了概率和单向敏感性分析。
在所有三组患者中，CI 的总效益均超过总成本，从而产生了 CI 的净效益。双侧 CI 的语前聋儿童具有终生积极的净效益，为 433,000 欧元。单侧 CI 的渐进性重度听力损失成人和老年人的总净效益分别为 275,000 欧元和 76,000 欧元。这些结果源于以货币形式表示的健康结果、教育成本的降低和生产力的提高。
基于建模估计，CI 导致的医疗保健成本增加被健康效益的价值以及教育和生产力成本的节省所弥补。特别是对于儿童和工作成年人，即使不考虑健康效益，社会效益也是积极的。因此，CI 为患者和社会带来了优势。
