Author(s)
Rajas Tipnis, MD FRCSC
Dylan Chan, MD PhD FAAP
James Lawrence, MPH
Affiliation(s)
Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
Abstract:
Background: Infants who are born deaf or hard of hearing (DHH) are at significant risk of delayed language acquisition. Cochlear implantation (CI) is a critical intervention in these infants resulting in improved speech and language development. There has been a shift towards earlier age of CI to six months with data demonstrating sustained improvement in language testing over time. Previous cost-utility analyses interrogating the impact of age at implantation are now outdated given the significant advances with lower age of infants being implanted.
Methods: Our team conducted a cost-utility analysis to characterize the health care value of earlier intervention comparing between CI at 6 and after 6 months of age. The Health Utilities Index Mark III (HUI3) was used to estimate the utility of earlier language access in terms of lifetime improvement in speech and hearing performance. These utility values were then used to estimate the lifetime quality-adjusted life year (QALY) benefit at a willingness to pay threshold of $100,000, with benefits discounted at 3% annually.
Results: Earlier CI (6 vs after 6 months) is associated with long-term global language benefit of +0.72 z-score, based on a previously published prospective trial. This was modeled as a one-level improvement in the Speech and Hearing subscales of the HUI3 Multi-Attribute Utility Function. The difference in multi-attribute utility resulting from earlier CI, therefore, yielded a projected lifetime benefit of 4.18 QALY. At a willingness-to-pay threshold of $100,000, this intervention yields a lifetime health care value of $418,000.
Discussion: Our study describes the health care value of earlier CI using cost-utility analysis. Comparison between earlier and later intervention yielded care value estimates of 4.18 QALY, resulting in a lifetime value of $418,000 by performing CI at 6 months. This benchmark may be used to inform cost-effectiveness of various health systems interventions to improve timeliness of CI for DHH children. In addition to the language benefit earned by individual patients with earlier CI, our modelling describes added health care value gained. Inclusion of additional direct economic benefits, such as reduction in special education costs, can further refine this analysis.