The Economics of Cochlear Implants and Deafness?

[jillio]

If the parents can't do it, then someone else. What is the issue there? As long as the child gets it.

And that is the whole point, owen06. Why can't the parents do it? But there is another thread devoted to this topic.

 

[loml]

Calm down. The administrators are watching us. LinuxGold did a good sticky post on the top of this subcategory. I agree with him we do not need more wars, but listen to both sides. For example, when you was provided with a research on early ASL, you discounted it's practical by claiming that ASL is too hard to learn for hearing parents in general, without backing up that claim with research.

flip - How is this statement: orginally posted by owen06

I think that ASL is great when children get an accurate portrayal of it.

Equal To this: orginally posted by flip

you was provided with a research on early ASL, you discounted it's practical by claiming that ASL is too hard to learn for hearing parents in general, without backing up that claim with research

You are free to make that claim, but you also have to accept that I don't care much about providing papers to people making this kind of replies to research. How many times do I have to expain this simple fact to you?

flip - If you can't provide any individual with the information you profess to have in your possession, then simple don't make such statements. You are familiar with the phrase "keeping your word" aren't you ? [/QUOTE]

 

[jillio]

The two statement you have copied are unrelated to each other. Stop attempting to confuse the issue by taking things totally out of context and attempting to show relation. It is only an attempt at diffusion.

 

[flip]

flip - How is this statement: orginally posted by owen06 Equal To this: orginally posted by flip


You are free to make that claim, but you also have to accept that I don't care much about providing papers to people making this kind of replies to research. How many times do I have to expain this simple fact to you?

flip - If you can't provide any individual with the information you profess to have in your possession, then simple don't make such statements. You are familiar with the phrase "keeping your word" aren't you ?

I am free to make statements based on information I have in my possession, and I am free to give it or not to anyone, and have explained why. It's not my problem you are uncomfortable with the explaination.

Regarding the statement from Owen06 and me, he will explain later according to himself. I think you have missed out something, and can understand it. The whole thing is getting so internal

Perhaps we should return to the topic for a while?

 

[Roadrunner]

Mod Note:


Please stick to which this thread is concerned with--cease the belittling among some of you--






~RR

 

[jag]

Nucleus Freedom is Designed to Mimic the path of Natural Hearing
One of the most incredible things about hearing is the way our brains learn to identify important sounds, while filtering out background sounds. Nucleus® Freedom™ is designed to mimic the functions of the human ear, by automatically distinguishing important sounds from everything else—just like natural hearing.

I personally find such innaccuracies as the bolded statement above, taken fromt he Nucleus Freedom website, to be offensive.

from personal experience with the freedom Ci and having had natural hearing (if you can call hearing with HA's natural) the CI is quite natural. The thing about the human brain is it can adapt and turn something like simulated sound from radio waves into what it recalls that sound as sounding like. The human brain is an amazing thing.

What we hear is really not much different the what you hear over the radio. Most voices coming over the radio through receivers now sound very normal. Then again normal is an individual thing.

 

[rick48]

jag,

Good to hear from you, its been too long!
Rick

 

[sr171soars]

from personal experience with the freedom Ci and having had natural hearing (if you can call hearing with HA's natural) the CI is quite natural. The thing about the human brain is it can adapt and turn something like simulated sound from radio waves into what it recalls that sound as sounding like. The human brain is an amazing thing.

What we hear is really not much different the what you hear over the radio. Most voices coming over the radio through receivers now sound very normal. Then again normal is an individual thing.

Indeed! Totally with you on that.

In response to some others in this thread...
Some folks can quibble over what is "natural" hearing until the end of the universe. I got much better things to do than argue about it...like living as the Romans do.

 

[Cloggy]

I've also read a couple of papers from the medical community stating that CI was considered to be more cost effective because it reduced the need for additional academic accommodations. Can't cite them right off, due to the fact that it was some time ago. I thinkt his is being disproved by the number of students with CI that continue to need transcription and/or interpreting services.

I think this is being proved by the number of students with CI that don't need transcription and/or interpreting services.

 

[Cloggy]

Some research...

Seems to be a lot of studies that see economical benefits in CI...

Cochlear implants in children: quality of life and costs.

Severens JL, Braspenning J, Van den Broek P.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1997; 13: 133.

Department of Medical Informatics, Epidemiology and Statistics, University of Nijmegen, Netherlands.

OBJECTIVE: to determine the quality of life in deaf children with cochlear implant (CI) compared to deaf children not being treated with CI and to determine the costs involved in CI.
METHODS: 18 pairs of children were included in this study. Of each pair of children, matched for hearing loss, cause of deafness, age, school, and sex, one child received a cochlear implant, the other acted as a control. The differences between the children were measured with three tools: an audiological questionnaire (MAIS), a visual analogue scale (VAS), and a newly developed questionnaire (QoL-SDC), measuring physical well-being, emotional well-being, social relations, autonomy and school performances. The cost analysis was based on the assumption that cost of CI were additional to costs normally involved treating deaf chidren. A time horizon of the life expectancy at an average age at the time of implantation was used. The cost analysis of selection of the child, implantation and rehabilitation were based on empirical data, where costs in future were based on planned after care. Costs and effects were dicsounted at 5%.
RESULTS: The children with CI had a significantly better audiological outcome (MAIS). The QoL-SDC proved to be a reliable and valid instrument. Except for the school performance, the difference in quality of life measured with QoL-SDC did not differ significantly. The utility score on the VAS was high and did not differ significantly between the children with and without CI (0.87 and 0.82 respectively). The total costs of the selection procedures starting with 106 children amounted $156,811. These costs were ascribed to the 20 finally implanted children, which resulted in $7,841 per CI child. Main costs of the implantation was the CI hardware ($25,518), resulting in $30,808 for implantation per child. Rehabilitation in the first year was $13,589 and after care considering the life expectancy costs $71,216. Based on the VAS a utility difference the cost per QALY gained were $127,648.
CONCLUSIONS: It can be concluded that the advantages of CI seem to outweigh its disadvantages, however, the costs of CI are considerable. For stable results more pairs of children should be included and a longer follow-up study is indispensable, because hardly anything is known about the long term effects on quality of life and about long term costs.

ECONOMIC EVALUATION OF COCHLEAR IMPLANT
Rob Carter a1 , and David Hailey a1 ,
a1 Monash University


Abstract

Objectives: To examine the economic efficiency of current cochlear implant technology under Australian conditions in profoundly deaf adults, partially deafened adults, and children

Methods:> Cost—utility study, with weights based on judgments from persons experienced with the technology, and cost data from Australian sources.

Results: Quality—of— improvements due to functional consequences of hearing improvement were greater than those due to amelioration of hearing disability. Costs in Australian dollars per QALY (15—year assessment) ranged from $5,070—$11,100 for children, $11,790—$38,150 for profoundly deaf adults, and $14,410—$41,000 for partially deaf adults.

Conclusions: Results suggest cochlear implantation is acceptable value for money when compared with other health programs to which resources are committed in Australia.

Cochlear implants: update and review of cost-utility studies. IPE-03/37 (Public report)
Rodriguez Garrido M, Manrique Rodriguez M, Asensio del Barrio C
The multichannel CI is a technique which allows acquisition of hearing in congenitally, prelingually deaf children, and improvement also in postlingually deaf children and adults, in a significant way when compared with patients without them. CI is indicated in patients with deep bilateral neurosensory deafness located in the cochlea, with adecuate motivation and unsuitable for any other prosthetic alternative, although maybe the criteria will be expanded in future. It is absolutely necessary to have a multi-disciplinary well integrated team and a program that permits the different phases (correct selection and follow-up of the patients, implantation, programation and rehabilitation). In the prelingually deaf children we deem that the age of implantation should be at its best at the interval of 2 and 5 years. Parents and patients should be informed of the potential benefits and risks of the technique in order to maximize rehabilitation benefits.

The preventive vaccination of all patients is recommended before treatment to reduce the number of meningitis cases. With more experience, it is hoped that the number of complications will decrease.

Costs and health quality of life from the different studies have proved the cost-utility of the CI, with a very good position in the cost-effective technologies ranking.

Impact of cochlear implants on the functional health status of older adults
Francis H W, Chee N, Yeagle J, Cheng A, Niparko J K
"Cochlear implantation in older adults is a highly cost-effective intervention for both groups of patients, as the cost-utility results are well below the threshold of $20,000 to $25,000 per QALY for procedures that are considered to be acceptable value for money".

Acta Otorrinolaringol Esp. 2006 Jan ;57 (1):2-23 16503028 (P,S,E,B)
[Analysis of the cochlear implant as a treatment technique for profound hearing loss in pre and postlocutive patients]
M Manrique, A Ramos, C Morera, C Cenjor, M J Lavilla, M S Boleas, F J Cervera-Paz
Estudio Multicéntrico realizado por los Grupos de Implantación Coclear de la Clínica Universitaria de Navarra, Pamplona. mmanrique@unav.es
INTRODUCTION: These are the objectives planned for this study: 1. Evaluate the results from the communication point of view. 2. Evaluate the cochlear implant (CI) impact on the quality of life. 3. Evaluate medical complications and technical failures. 4. Assess direct and indirect costs generated during the phases of a cochlear implantation programme. 5. Determine which factors have a high impact on the clinical evolution and the financial cost.
MATERIALS AND METHOD: A population of 877 patients, postlingual and prelingual, adults and children, have been studied. They were treated in 5 Spanish centres with cochlear implant programmes. Audiometric tests and global questionnaires on life quality have been carried out. Medical and CI technology complications have also been computed. Direct and indirect economic costs of a cochlear implant have been calculated. RESULTS: Postlocutive-implanted patients reached the 40 dB SPL threshold in the Pure Tone Audiometry, and this result was maintained during the 12-year evolution. In Vowels test, it evolved from a 30% on pre-stimulation to 80-90%, in Disyllables words test it evolved from a 10% to a 50-60%, and in CID Sentences test it evolved from an 18% to a 60-70%. In the prelocutive population, results were influenced by the child's age at implantation. The best results were obtained by the children who had been implanted earlier. Those implanted between 0 and 3 years old evolved in the Vowels test from 0% during pre-stimulation to 95%, from a 0% to a 90% in Disyllables words test and from a 0% to a 90-95% in CID Sentences test. Also, the speech acquisition and development of the pre-locutive population was also influenced by the implantation age. An 80% of postlocutive adult patients stated a mood and sociability improvement after the cochlear implantation. They did not show health changes in general nor relevant modifications in the attention they usually received from relatives and friends. Severe medical-surgical complications were registered for a 3.42% of the cases, a 7.06% of mild medical-surgical complications and a 3.07% of technical breakdowns in the internal components of the CI. Financial cost of implantation for a post-locutive adult oscillated between 36,912 Euro and 37,048 Euro, and between 37,689 Euro and 44,273 Euro for a pre-locutive child. CONCLUSIONS: Cochlear implants clearly enhance communication skills of the implantees. Results obtained for the prelocutive implanted population justify the creation of hearing screening programmes in new-borns. Postlocutive implanted adults have expressed satisfaction for the results obtained. However, they did perceive some limitations in situations of unfavourable acoustic conditions. An analysis of direct and indirect costs related to a CI programme has been made. It may be useful to carry out reports on the cost-benefit ratio in this field. The low index of complications observed shows which cochlear implant treatment technique complies with the adequate safety margins. The factors influencing the most in the evolution are: duration of hearing deprivation, age at implantation, cochlear anatomy and functionality of the auditory pathway, patient's and relative's motivation, and the coexistence of other handicaps associated to hearing losses.

Cost-utility analysis of the cochlear implant in children.
A K Cheng, H R Rubin, N R Powe, N K Mellon, H W Francis, J K Niparko
Department of Otolaryngology, Division of Otology Neurotology, Johns Hopkins University, 601 N. Carolina St, Baltimore, MD 21287-0910, USA.
CONTEXT: Barriers to the use of cochlear implants in children with profound deafness include device costs, difficulty assessing benefit, and lack of data to compare the implant with other medical interventions.
OBJECTIVE: To determine the quality of life and cost consequences for deaf children who receive a cochlear implant.
DESIGN: Cost-utility analysis using preintervention, postintervention, and cross-sectional surveys conducted from July 1998 to May 2000.
SETTING: Hearing clinic at a US academic medical center.
PARTICIPANTS: Parents of 78 profoundly deaf children (average age, 7.5 years) who received cochlear implants.
MAIN OUTCOME MEASURES: Direct and total cost to society per quality-adjusted life-year (QALY) using the time-trade-off (TTO), visual analog scale (VAS), and Health Utilities Index-Mark III (HUI), discounting costs and benefits 3% annually. Parents rated their child's health state at the time of the survey and immediately before and 1 year before implantation.
RESULTS: Recipients had an average of 1.9 years of implant use. Mean VAS scores increased by 0. 27, from 0.59 before implantation to 0.86 at survey. In a subset of participants, TTO scores increased by 0.22, from 0.75 to 0.97 (n = 40) and HUI scores increased by 0.39, from 0.25 to 0.64 (n = 22). Quality-of-life scores were no different 1 year before and immediately before implantation. Discounted direct costs were $60,228, yielding $9,029 per QALY using the TTO, $7,500 per QALY using the VAS, and $5,197 per QALY using the HUI. Including indirect costs such as reduced educational expenses, the cochlear implant provided a savings of $53,198 per child.
CONCLUSIONS: Cochlear implants in profoundly deaf children have a positive effect on quality of life at reasonable direct costs and appear to result in a net savings to society. JAMA. 2000;284:850-856

 

[jag]

jag,

Good to hear from you, its been too long!
Rick

I've been having a good time living my life to the fullest and one of my daughters just had twins 2 months ago (gee time flies they're already 2 months old eek!!) so I've been enjoying time holding and cuddling the new babies.

One can not read these comments on CI's and just pop in and pick up where one left off even if you haven't been here for quite some time. same old same old.

 

[jillio]

from personal experience with the freedom Ci and having had natural hearing (if you can call hearing with HA's natural) the CI is quite natural. The thing about the human brain is it can adapt and turn something like simulated sound from radio waves into what it recalls that sound as sounding like. The human brain is an amazing thing.

What we hear is really not much different the what you hear over the radio. Most voices coming over the radio through receivers now sound very normal. Then again normal is an individual thing.

My problem with the statement is the implication, very explicit, that the CI is responsible for discrimination. This is blatantly untrue. The individual must be trained in discrimination ability. It does not automatically occur upon implantation. And discrimination will vary according to individual.

I agree, normal is subjective. However, to a hearing parent reading such a statement soon after diagnosis of their child, and expecially one who has no perspective pn which to base a subjective definition of "normal" other than their own hearing perspective, "normal" will be defined as "the same as someone who has had hearing all of their lives."

 

[jillio]

I think this is being proved by the number of students with CI that don't need transcription and/or interpreting services.

And where are you finding these students, cloggy? Can you provide some statistics for your claim? Likewise, not recieving, and not needing are two very different situations. I would be interested in seeing some hard evidence of this "proof" of which you speak. I know from personal experience that I do not have a single student with CI that does not require additional accommodation. The large numbers of students with CI that are being transferred to shel's school, as well, obviously require additional accommodation. The public school system that another parent on this board has enrolled her 2 deaf implanted children in was sued in order to provide transcription services, despite the mother's claim that these children can "hear" everything said to them without need for visual cues. I am certain that anyone involved with deaf ed or anyone that is resposnible for insuring that services are provided as needed to deaf students will cite the same experience. I am truly curious as to where these students of which you speak are located.

 

[jillio]

I've been having a good time living my life to the fullest and one of my daughters just had twins 2 months ago (gee time flies they're already 2 months old eek!!) so I've been enjoying time holding and cuddling the new babies.

One can not read these comments on CI's and just pop in and pick up where one left off even if you haven't been here for quite some time. same old same old.

Congratulations on the birth of the twins!

 

[jillio]

Seems to be a lot of studies that see economical benefits in CI...

These abstracts also claim that the studies are inconclusive. And should the focus be, in recommeding CI, the finanacial cost to a society, or the personal benefit of the individual? They are not one and the same. There are numerous claims from the medical establishment that cost to society is reduced by implantation, and that focus alone is evidence of their perspective regarding deafness as pathology. Personally, I would prefer a doctor who sees a patient as an individual, and bases treatment on that, rather than one who views patients as something pathological that must be corrected to benefit society without concern regarding the effects such treatment has, first and foremost, on the individual being treated.

 

[neecy]

I'd like to lend a bit of personal experience- in Dec, I finished two sessions of classes at my local community college, and was able to do everything on my own, without needing a note-taker or interpreter. I tried that once, more than 15 years ago at the same college, back when I only had my hearing aids, and failed miserably. I know its just one experience, but it shows that not everybody needs the extra assistance once having CI's. I don't.

 

[jillio]

I'd like to lend a bit of personal experience- in Dec, I finished two sessions of classes at my local community college, and was able to do everything on my own, without needing a note-taker or interpreter. I tried that once, more than 15 years ago at the same college, back when I only had my hearing aids, and failed miserably. I know its just one experience, but it shows that not everybody needs the extra assistance once having CI's. I don't.

Again, neecy, you are postlingual. The issues are quite different for prelingually deafened. I have a postlingual student without CI who uses an FM system quite successfully, as well. However, that is not an indication that the prelingual students with a CI are able to function with such minimal accomodations. All of my prelingual students, both with CI and without, require terps, preferential seating, professional notetakers, and extended time in testing.

I am happy that you are able to get by without additional accommodations, and wish you success in your edcuational endeavors. However, you are the exception, rather than the rule.

 

[neecy]

I REALIZE that I'm post-lingual. You don't need to point that out. I was simply stating that it IS possible. I have learned quick that posting anything positive in this forum regarding CI's is like tip-toe'ing through a minefield, and I have to put an *** on every single thing I say because invariably, it will be discounted because I'm post-lingual.

Not every person who has a CI is going to be pre-lingual, Jillio. There are SO many people who have experiences similar to mine, and having a CI *WILL* make a difference in their lives. Will their experiences be discounted as well? Or told that they're not the norm? Is this a forum for pre-linguals only? Or should there be some requirement that everybody list before their posts whether they're pre or post lingual so to avoid confusion?

It seems that whenever somebody shares an CI experience, if they are an adult they are treated differently, almost as if this is a forum just for CI-implanted pre-lingual CHILDREN, and nothing about adults, be the pre or post lingual. Should a separate forum for CI's in adults be made so we can stop this?

 

[jillio]

I REALIZE that I'm post-lingual. You don't need to point that out. I was simply stating that it IS possible. I have learned quick that posting anything positive in this forum regarding CI's is like tip-toe'ing through a minefield, and I have to put an *** on every single thing I say because invariably, it will be discounted because I'm post-lingual.

Not every person who has a CI is going to be pre-lingual, Jillio. There are SO many people who have experiences similar to mine, and having a CI *WILL* make a difference in their lives. Will their experiences be discounted as well? Or told that they're not the norm? Is this a forum for pre-linguals only? Or should there be some requirement that everybody list before their posts whether they're pre or post lingual so to avoid confusion?

It seems that whenever somebody shares an CI experience, if they are an adult they are treated differently, almost as if this is a forum just for CI-implanted pre-lingual CHILDREN, and nothing about adults, be the pre or post lingual. Should a separate forum for CI's in adults be made so we can stop this?

Your experiences are not being discounted, they are simply being qualified. And, no this forum is not for prelinguals only. But the difference does need to be pointed out, particularly in the case of a parent of a prelingually deafened child. They need to know that it is not reasonable to expect that a prelingually deafened child will not have the same level of success as a postlingually deafened adult.

I have no idea why you become so defensive when that is pointed out. It in no way invalidates your experience; it simply puts it in a proper perspective. It is great that you have experienced the success you have with your CI. I wih you all the best with continued success. That has nothing to do with the fact that your experience is qualitatively and quantitatively different from those who are prelingually deafened. The vast majority of students fit into the the prelingual category. Therefore, there educational experiences and needs are quite different from yours. It is neither a judgement regarding your experience, nor a judgement regarding their experience. It is simply a fact.

 

[neecy]

I get defensive because I have had the experience of people telling me point blank that my accomplishments and experiences are not worth listening to *because* I'm post lingual. It came across as "more of the same." Glad its not that way, and thank you for your good thoughts.