Abstract
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.
Similar content being viewed by others
References
Lenarz, T.: Cochlear implant, state of the art. Laryngorhinootologie 96, S123–S151 (2017)
Tu, N.C., Friedman, R.A.: Age-related hearing loss, unraveling the pieces. Laryngoscope Investig. Otolaryngol. 3, 68–72 (2018)
World Health Organization, Deafness and hearing loss, https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss. Accessed 23 Feb 2018
von Gablenz, P., Holube, I.: Prävalenz von Schwerhörigkeit im Nordwesten Deutschlands, Ergebnisse einer epidemiologischen Untersuchung zum Hörstatus (HÖRSTAT). HNO 63, 195–214 (2015)
Borchgrevink, H.M., Tambs, K., Hoffman, H.J.: The Nord-Trøndelag Norway Audiometric Survey 1996–98, Unscreened thresholds and prevalence of hearing impairment for adults 20 years. Noise Health 7, 1–15 (2005)
Roth, T.N., Hanebuth, D., Probst, R.: Prevalence of age-related hearing loss in Europe, a review. Eur. Arch. Otorhinolaryngol. 268, 1101–1107 (2011)
Raths, S., Lenarz, T., Lesinski-Schiedat, A., Flessa, S.: Kostenanalyse der unilateralen Cochlea-Implantatversorgung bei Erwachsenen. Laryngorhinootologie 95, 251–257 (2016)
Reimbursement Institute, G-DRG analysis 2013–2016, OPS 5-209.2 in all hospitals. https://reimbursement.info/analysen/. Accessed 20 Apr 2018
Foteff, C., Kennedy, S., Milton, A.H., Deger, M., Payk, F., Sanderson, G.: Cost-utility analysis of cochlear implantation in Australian adults. Otolo. Neurotol. 37, 454–461 (2016)
Chen, J.M., Amoodi, H., Mittmann, N.: Cost-utility analysis of bilateral cochlear implantation in adults, A health economic assessment from the perspective of a publicly funded program. Laryngoscope 124, 1452–1458 (2014)
Francis, H.W., Chee, N., Yeagle, J., Cheng, A., Niparko, J.K.: Impact of cochlear implants on the functional health status of older adults. Laryngoscope 112, 1482–1488 (2002)
UK Cochlear Implant Study Group: Criteria of candidacy for unilateral cochlear implantation in postlingually deafened adults II, Cost-effectiveness analysis. Ear Hear. 25, 336–360 (2004)
Summerfield, A.Q., Marshall, D.H., Barton, G.R., Bloor, K.E.: A cost-utility scenario analysis of bilateral cochlear implantation. Arch. Otolaryngol. 128, 1255–1262 (2002)
Smulders, Y.E., van Zon, A., Stegeman, I., van Zanten, G.A., Rinia, A.B., et al.: Cost-utility of bilateral versus unilateral cochlear implantation in adults, a randomized controlled trial. Otol. Neurotol. 37, 38–45 (2016)
Molinier, L., Bocquet, H., Bongard, V., Fraysse, B.: The economics of cochlear implant management in France, a multicentre analysis. Eur. J. Health Econ. 10, 347–355 (2009)
Health Quality Ontario, Bilateral cochlear implantation, a health technology assessment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235073/pdf/ohtas-18-1.pdf. Accessed 17 Jan 2020
Lenarz, T., Boenninghaus, H.-G.: Hals-Nasen-Ohren-Heilkunde. Springer, Berlin, Heidelberg (2012)
Müller-Gronbach, T., Novak, E., Ritter, K.: Monte Carlo-Algorithmen. Springer, Berlin (2012)
Waldmann, K.-H., Helm, W.E.: Simulation stochastischer Systeme, Eine anwendungsorientierte Einführung. Gabler, Berlin (2016)
Rosenberg, C., Kroos, K., Rosenberg, B., Hosten, N., Flessa, S.: Teleradiology from the provider's perspective-cost analysis for a mid-size university hospital. Eur. Radiol. 23, 2197–2205 (2013)
Cochlear-Implant-Centrum CICERO, Allgemeine Informationen. https://www.hno-klinik.uk-erlangen.de/cicero/ci-information-fuer-patienten/allgemeine-informationen/. Accessed 4 March 2020
Spitzenverband Bund der Krankenkassen, Kennzahlen der gesetzlichen Krankenversicherung. https://www.gkv-spitzenverband.de/gkv_spitzenverband/presse/zahlen_und_grafiken/zahlen_und_grafiken.jsp. Accessed 03 Feb 2020
Limpert, E., Stahel, W.A., Abbt, M.: Log-normal distributions across the Sciences, Keys and Clues. Bioscience 51, 341 (2001)
Deutsches Hörzentrum Hannover, Kosten der CI-Versorgung, Interne Auswertung 2013–2017 (2018)
Lane, C., Zimmerman, K., Agrawal, S., Parnes, L.: Cochlear implant failures and reimplantation: a 30-year analysis and literature review. Laryngoscope 130, 782–789 (2020)
Kießling, J., Kollmeier, B., Baumann, U.: Versorgung mit Hörgeräten und Hörimplantaten. Georg Thieme Verlag, Stuttgart (2018)
Institut für das Entgeltsystem im Krankenhaus, G-DRG-Report-Browser. https://www.g-drg.de/Datenbrowser_und_Begleitforschung/G-DRG-Report-Browser/G-DRG-Report-Browser_2019. (2019)
Gemeinsamer Bundesausschuss, Richtlinie über die Verordnung von Heilmitteln in der vertragsärztlichen Versorgung, Zweiter Teil: Zuordnung der Heilmittel zu Indikationen nach § 92 Absatz 6 Satz 1 Nummer 2 SGB V (Heilmittelkatalog). https://www.g-ba.de/downloads/62-492-1399/HeilM-RL_2017-03-16_iK-2017-05-30.pdf. Accessed 23 Jan 2018
Verband der Ersatzkassen, Vergütungsliste gemäß § 125 SGB V für die Abrechnung stimm-, sprech-, sprachtherapeutischer Leistungen, Anlage 3 zum Rahmenvertrag vom 01.01.2014, gültig ab 01.10.2017. https://www.vdek.com/vertragspartner/heilmittel/preisvereinbarungen/_jcr_content/par/download_59/file.res/Preisliste_17-18_NDS_dba,dbl,dbs_UF.pdf. Accessed 4 Dec 2017
Statistisches Bundesamt, Sterbetafel (Periodensterbetafel): Deutschland, Jahre, Geschlecht, Vollendetes Alter. https://www-genesis.destatis.de/genesis/online/link/tabellen/12621* (2017). Accessed 10 March 2018
von der Schulenburg, J.-M., Greiner, W., Jost, F., Klusen, N., Kubin, M., et al.: Deutsche Empfehlungen zur gesundheitsökonomischen Evaluation, dritte und aktualisierte Fassung des Hannoveraner Konsens. Gesundh ökon Qual manag 12, 285–290 (2007)
Statistisches Bundesamt, Bevölkerungsentwicklung bis 2060, Ergebnisse der 13. koordinierten BevölkerungsvorausberechnungAktualisierte Rechnung auf Basis. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Bevoelkerungsvorausberechnung/Publikationen/Downloads-Vorausberechnung/bevoelkerung-bundeslaender-2060-aktualisiert-5124207179004.pdf. (2015) Accessed 12 March 2018
Foreman, K.J., Marquez, N., Dolgert, A., Fukutaki, K., Fullman, N., et al.: Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death, Reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet 392, 2052–2090 (2018)
Wilson, B.S.: The cochlear implant and possibilities for narrowing the remaining gaps between prosthetic and normal hearing. World J. Otorhinolaryngol. 3, 200–210 (2017)
Universität Rostock, RESPONSE, Innovationen, Implantate für das Ohr. https://www.response.uni-rostock.de/innovationen. Accessed 20 Dec 2018
Holcomb, M.A., Burton, J.A., Dornhoffer, J.R., Camposeo, E.L., Meyer, T.A., McRackan, T.R.: When to replace legacy cochlear implants for technological upgrades, Indications and outcomes. Laryngoscope 129, 748–753 (2019)
Gaylor, J.M., Raman, G., Chung, M., Lee, J., Rao, M., et al.: Cochlear implantation in adults, a systematic review and meta-analysis. JAMA Otolaryngol. Head Neck Surg. 139, 265–272 (2013)
van Schoonhoven, J., Sparreboom, M., van Zanten, B.G., Scholten, R.J., Mylanus, E.A., et al.: The effectiveness of bilateral cochlear implants for severe-to-profound deafness in adults. Otol. Neurotol. 34, 190–198 (2013)
Lottner, A., Iro, H., Schützenberger, A., Hoppe, U.: Das Cochleaimplantat in der sozialgerichtlichen Rechtsprechung. HNO 66, 135–143 (2018)
Müller, J.: Bilaterale Cochleaimplantatversorgung. HNO 65, 561–570 (2017)
Funding
This research was funded by Bundesministerium für Bildung und Forschung, Grant number [03ZZ0914C].
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Thum, C., Lenarz, T., Lesinski-Schiedat, A. et al. Lifetime cost of unilateral cochlear implants in adults: a Monte Carlo simulation. Eur J Health Econ 21, 963–975 (2020). https://doi.org/10.1007/s10198-020-01188-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10198-020-01188-7