Cost analysis of cochlear implants in deaf children in The Netherlands.

OBJECTIVE The purpose of the study was to determine the costs of cochlear implants in children regarding the phases of selection, implantation, rehabilitation, and aftercare. STUDY DESIGN This study was a prospective cost analysis paralleling a noncomparative observational study. SETTING This study was conducted at a university hospital to evaluate cost data on selection and implantation and at an institute for the deaf to evaluate cost data on rehabilitation and aftercare. PATIENTS The study group consisted of prelingual deaf children (mean age, 7 years; range, 4-11 years). INTERVENTION A total of 106 deaf children were screened, of whom 20 received a cochlear implant. MAIN OUTCOME MEASURES This study concentrated on the cost of cochlear implants. Volumes of utilization of human resources and materials were registered during the 1-year follow-up. For the subsequent period, volumes were modeled on planned aftercare activities. RESULTS Real total medical costs per implanted child were $63,922; selection phase, $7,747; implantation phase, $30,442; rehabilitation phase, $13,428; and aftercare, $12,305. Nonmedical costs were $1,839. Calculations were based on 1994 prices, and a time horizon of 5 years was used. The economic consequences of cochlear implants on educational needs were not taken into account because of the limited follow-up period. A sensitivity analysis of the rate of implanted children as part of the number of screened children showed a moderate impact on the total cost. CONCLUSIONS Compared to the results of cost analysis in other countries, the costs of the pediatric cochlear implants program in The Netherlands are relatively high. Most discrepancies can be explained by methodologic differences in the cost analyses.