Direct cost of cochlear implants in Germany - a strategic simulation.

BACKGROUND: Despite the current undersupply of cochlear implants (CIs) with simultaneously increasing indication, CI implantation numbers in Germany still are at a relatively low level. METHODS: As there are hardly any solid forecasts available in the literature, we develop a System Dynamics model that forecasts the number and costs of CI implantations in adults for 40 years from a social health insurance (SHI) perspective. RESULTS: CI demand will grow marginally by demographic changes causing average annual costs of about 538 million €. Medical-technical progress with following relaxed indication criteria and patients' increasing willingness for implantation will increase implantation numbers significantly with average annual costs of 765 million €. CONCLUSION: CI demand by adults will increase in the future, thus will the costs for CI supply. Continuous research and development in CI technology and supply is crucial to ensure long-term financing of the growing CI demand through cost-reducing innovations.

[Lifetime Cost of Hearing Aids in Germany]. / Lebenszeitkosten der Hörgeräteversorgung in Deutschland.

OBJECTIVE: Hearing aids are the standard treatment of hearing loss, which is covered by the statutory health insurance (SHI) in Germany. In chronic cases, hearing aid therapy causes periodic costs until the patient's death. This analysis examines the average lifetime cost of adult patients with regard to the age at initial treatment and presents them both from the perspective of the SHI and the insured. METHODS: In the base case, we consider the supply of hearing aids free of charge. A treatment pathway is developed and used to identify the cost components incurred over the lifetime. Subsequently, the present value lifetime cost of monaural and binaural hearing aid supply are calculated. RESULTS: The binaural (monaural) hearing aid supply for an adult (first hearing aids received between 18 and 88 years) causes average present value lifetime cost of €â€Š4518 (€â€Š2536) from the perspective of the statutory health insurance. The patient bears an average of €â€Š4610 (€â€Š3672) total cost. There are specific lifetime costs for each individual age of initial treatment. Generally, lifetime cost decreases with the patient's increasing age at initial treatment. CONCLUSIONS: Patients finance a substantial part of the hearing aid treatment. If the patient decides for high-end hearing aids instead of hearing aids free of charge, the total patient cost increases to an average of €â€Š7953 for binaural supply. Due to continuous technical progress and development of hearing systems, rising expenses for hearing aid supply can be assumed.

Lifetime cost of unilateral cochlear implants in adults: a Monte Carlo simulation.

BACKROUND/OBJECTIVE: Due to increasing prevalence of hearing loss and relaxation of candidacy criteria of cochlear implant (CI) supply, the number of implantations is likely to further increase. Statutory health insurances are facing ever more urgent financing challenges since CI treatment causes high life-long costs. Additionally, increasing life expectancy and earlier implantation may extend therapy time and cost. With every case being individual, this study aims to calculate the possible lifetime cost of unilateral CI treatment in adults including stochastic uncertainties. METHODS: Taking a statutory health insurance perspective, relevant cost components of CI therapy and their values were identified. The Monte Carlo method was used to simulate lifetime cost considering age at first implantation and distributions of costrelevant variables. A sensitivity analysis was conducted to determine the most crucial variables impacting on lifetime cost. RESULTS: Lifetime cost of CI treatment varies according to age at first implantation, respectively remaining lifetime; the earlier the implantation, the higher the overall cost. According to our simulation, the average lifetime cost for an adult patient first implanted between the age of 20-80 is at 53,030 € (present value). Cost of implantation and periodic speech processor exchanges show the highest impact on the total cost. DISCUSSION: Health care systems could face rising expenses for CI supply by technical development. Innovative life-long CIs could achieve significant savings per case that could finance additional implant cost. Until then, further targeted research will be required. CONCLUSION: CI-related cost for statutory health insurance crucially depends on the patient-side demand for cochlear implants. Therefore, cost forecasts must also consider the development of demand.

Systems Medicine: hype or revolution?

Research and innovation in healthcare can change existing practices aiming at constant improvement of diagnosis, treatment and prevention. As a new holistic approach Systems Medicine (SM) may revolutionize the healthcare system. This paper analyzes ethical and economic obstacles of SMs development from a niche innovation to a standard solution. We adapt a model of innovation theory to structure the barriers of adopting SM to become standard in the medical system. SM has the potential to change the medical system if barriers to this innovation can be overcome. The article discusses the potential of SM in becoming the future health paradigm considering these barriers and provides an overview of the current situation.