Susan D Emmett1,2,3, Chad K Sudoko4, Debara L Tucci1,2, Wenfeng Gong5, James E Saunders6, Nasima Akhtar7, Mahmood F Bhutta8, Sokdavy Touch9, Rabindra Bhakta Pradhananga10, Nadeem Mukhtar11, Norberto Martinez12, Frances Dianne Martinez12, Hubert Ramos12, Mohan Kameswaran13, Raghu Nandhan Sampath Kumar13, Soekirman Soekin14, Narayanan Prepageran15. 1. Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA. 2. Duke Global Health Institute, Durham, North Carolina, USA. 3. Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA. 4. Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 5. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 6. Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA. 7. Department of Otolaryngology-Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 8. Department of Ear, Nose, and Throat Surgery, Brighton and Sussex University Hospitals, Brighton, UK. 9. Children's Surgical Centre, Phnom Penh, Cambodia. 10. Department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj Medical College, Kathmandu, Nepal. 11. Audiology Centre, Lahore, Pakistan. 12. University of Santo Tomas, Manila, Philippines. 13. Department of Implantation Otology, Madras ENT Research Foundation, Chennai, India. 14. Proklamasi ENT-HNS Institute, Jakarta, Indonesia. 15. Department of Otolaryngology-Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia.
Abstract
OBJECTIVE: To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia. STUDY DESIGN: Cost-effectiveness analysis. SETTING: Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study. SUBJECTS AND METHODS: Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3. RESULTS: Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)-the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39). CONCLUSION: Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.
OBJECTIVE: To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia. STUDY DESIGN: Cost-effectiveness analysis. SETTING: Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study. SUBJECTS AND METHODS: Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3. RESULTS: Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)-the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39). CONCLUSION: Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.
Entities:
Keywords:
cochlear implant; cost-effectiveness; deaf education; pediatric; sensorineural hearing loss
Authors: Ethan D Borre; Mohamed M Diab; Austin Ayer; Gloria Zhang; Susan D Emmett; Debara L Tucci; Blake S Wilson; Kamaria Kaalund; Osondu Ogbuoji; Gillian D Sanders Journal: EClinicalMedicine Date: 2021-05-08