Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

HYPOTHESIS: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. BACKGROUND: CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. METHODS: Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. 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 using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)<3. RESULTS: Deaf education was very cost effective in all countries (CER/GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). CONCLUSION: Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

Bimodal benefits of cochlear implant and hearing aid (on the non-implanted ear): a pilot study to develop a protocol and a test battery.

ABSTRACT This is a pilot study that aims (1) to help design a protocol for fitting and optimizing cochlear implants and hearing aids, (2) to help design a test battery that can help monitor children's progress and (3) to assess the benefit of using a cochlear implant with a contralateral hearing aid. Seven children between the ages of seven and 15 years completed the study. None of them had worn a contralateral hearing aid (HA) since cochlear implantation (five to seven years after implantation). The Listening Inventory for Education (LIFE), Life Situation Questionnaire (LSQ), and Client Orientated Scale of Improvement for Children (COSI-C) questionnaires together with subject's feedback were used as subjective measures, and speech perception tests - the City of New York (sentences list) (CUNY) and Bamford-Kowal-Bench (sentences list) (BKB) depending on child's speech perception skills - in quiet and in noise were used as objective measures. The results showed mixed subjective feedback, even though objectively all children improved their speech perception scores when wearing cochlear implants and hearing aids. The COSI-C proved to be the most successful tool to collect feedback from parents.