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

In Brief Objectives: 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? Methods: 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 €uros (€) 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. Results: 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 for a family whose child was implanted at age 3 yr and €949 for a child implanted at age 6 yr. These costs correspond, at most, to 3% of the incremental health-sector costs of implantation. Conclusions: 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. This paper assesses whether the economic costs incurred by the families of hearing-impaired children differ between implanted and non-implanted children. Analyses of cross-sectional data for ~2000 children demonstrated that, compared to the families of non-implanted children, out-of-pocket expenditure was significantly higher when children were implanted before the age of five years and had used their implant for less than two years, as was lost productivity when children had used their implants for less than two years. Between implantation and age sixteen years, the mean cumulative economic cost incurred by the families of implanted children was estimated to range between €949 and €3787, and to be up to 3% of the incremental health sector costs of implantation. Thus, though the economic impact of implantation may be material for the family of an implanted child, it is small in relation to the societal cost of providing cochlear implants to children.