Economics of Cochlear Implant Utilization

Topic: Risk, prevention and care in population studies

The decision of whether to utilize CI results from a shared decision-making process involving patients and their providers. By dividing the costs of treatment delivery by a patient's expected increase in QALYs, the cost-effectiveness ratio provides a measure for cost per QALY, with lower values associated with more cost-effective treatment. Economics literature suggests that $100,000 is a reasonable, even conservative, estimate for the value Americans typically place on an additional QALY,3 though insurers often apply a lower threshold (e.g., $50,000/QALY) when determining whether to cover a new treatment. The cost-effectiveness of CI for SPHL adults (traditional CI candidacy) is well documented, demonstrating significant QofL improvement that is higher among CI recipients than in non-implanted peers and equivalent to that in normal-hearing peers.4 Although younger age is associated with greater QofL improvement, a positive effect has also been observed in older adults.5 Research has shown that a greater proportion of cost-effectiveness is achieved with the first CI in bilateral SPHL (Table 1). Taken together, it is unsurprising that providers would focus on the incremental cost of CIs over hearing aids (HAs) and conclude that CIs are too expensive to recommend. Independent of patients’ WTP, insurance influences health care consumption decisions by determining what patients pay for care.8 CI recipients who are uninsured or don't meet their payer's guidelines for CI coverage typically face an expense of around $70,000, compared with an average expense of $3,100 from continuing the use of a hearing aid in a non-implanted ear (Table 2). Financing CIs out-of-pocket (OOP) would place a significant burden on the typical household, leading to the common view that CIs are “not affordable.” However, CIs tends to be covered by insurance while HAs often go uncovered, which has the effect of dramatically reducing the incremental OOP cost of a CI to the patient (Table 2). As a result, the incremental OOP cost a SPHL patient faces is generally small or even negative in some cases. Importantly, cost-effectiveness evidence suggests that there should be high CI utilization rates in the general SPHL population, even in the absence of insurance.

@article{votruba2019-b70a196b,
  author  = {Votruba, Mark Edward and Sydlowski, Sarah A.},
  title   = {{Economics of Cochlear Implant Utilization}},
  journal = {The Hearing Journal},
  year    = {2019},
  doi     = {10.1097/01.hj.0000602912.91566.64},
  url     = {https://doi.org/10.1097/01.hj.0000602912.91566.64}
}

Key findings

• The decision of whether to utilize CI results from a shared decision-making process involving patients and their providers.
• By dividing the costs of treatment delivery by a patient's expected increase in QALYs, the cost-effectiveness ratio provides a measure for cost per QALY, with lower values associated with more cost-effective treatment.
• Economics literature suggests that $100,000 is a reasonable, even conservative, estimate for the value Americans typically place on an additional QALY,3 though insurers often apply a lower threshold (e.g., $50,000/QALY) when determining whether to cover a new treatment.
• The cost-effectiveness of CI for SPHL adults (traditional CI candidacy) is well documented, demonstrating significant QofL improvement that is higher among CI recipients than in non-implanted peers and equivalent to that in normal-hearing peers.4 Although younger age is associated with greater QofL improvement, a positive effect has also been observed in older adults.5 Research has shown that a greater proportion of cost-effectiveness is achieved with the first CI in bilateral SPHL (Table 1).
• Taken together, it is unsurprising that providers would focus on the incremental cost of CIs over hearing aids (HAs) and conclude that CIs are too expensive to recommend.

Why it matters

This paper examines the cost-effectiveness of cochlear implants for adults with hearing loss, including older adults. It contains no information about treating, curing, or preventing Alzheimer's disease.

Study details

• Evidence strengthLow

Read the original

• DOI: 10.1097/01.hj.0000602912.91566.64
• Original source →

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