Hearing-Impaired Children in the United Kingdom, III: Cochlear Implantation and the Economic Costs Incurred by Families

Abstract

This article addresses two questions. First, are there differences in the economic costs incurred by families of hearing-impaired children depending on whether or not children have cochlear implants? Second, are these differences important when assessed from the perspective of society? In a cross-sectional survey, parents of a representative sample of hearing-impaired children provided data about annual resources used by the family because of their child's hearing impairment. The data yielded estimates of two variables: out-of-pocket expenditure and time away from normal activities by parents. The economic cost of the two variables was estimated in euros at 2001/2 price levels, and summed to estimate the overall economic cost incurred by the family. Linear regression was used to estimate the association between costs and implantation, while controlling for average (unaided, preoperative) hearing level, age at onset of hearing impairment, age, gender, the number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The cumulative economic cost incurred by the families of implanted children, between implantation and age 16 yr, was calculated from estimates of the overall economic cost associated with implantation and compared with estimates of the incremental health-sector cost of implantation. Data were provided by the families of 2858 children, 468 of whom had received a cochlear implant. Compared with the families of nonimplanted children, out-of-pocket expenditure was estimated to be significantly higher for families when children were implanted before the age of 5 yr and had used their implant for less than 2 yr, as was lost productivity when children had used their implants for less than 2 yr. Overall economic cost was estimated to be significantly higher for the families of implanted children who had used their implants for less than 2 yr. The cumulative economic cost was estimated to be 3355 euros for a family whose child was implanted at age 3 yr and 949 euros for a child implanted at age 6 yr. These costs correspond, at most, to 3% of the incremental health-sector costs of implantation. Compared with families of nonimplanted children, families of implanted children incur additional costs in the 2 yr after implantation. These costs are small in relation to the health-sector costs of providing implantation.