Hearing-Impaired Children in the United Kingdom, II: Cochlear Implantation and the Cost of Compulsory Education

In Brief Objective: The objective of this study was to estimate the impact of cochlear implantation on the cost of compulsory education of hearing-impaired children in the United Kingdom. Study Design: In a cross-sectional survey, teachers were asked to report the school placement of, and amount of support provided to, a representative sample of hearing-impaired children. Costs of school placement were obtained from published sources. Costs of support were calculated from a survey of 11 special education services. The annual education cost (in €uros at 2001/2002 levels) of each child was calculated by summing the placement and support costs. Linear regression analyses calculated the association between annual education cost and possession of an implant while controlling nine other variables: average (unaided, preoperative) hearing level (AHL), age at onset of hearing impairment, age, gender, the number of additional disabilities, parental occupational skill level, ethnicity, parental hearing status, and academic achievement. Results: Data were received for 2241 children, 383 of whom had cochlear implants. Mean annual education cost ranged from €15,745 for children with moderate hearing impairments to €30,071 for nonimplanted children with profound hearing impairments and was €28,058 for implanted children. A lower annual education cost was associated with a more favorable AHL, a later age at the onset of hearing impairment, female gender, a younger age, fewer additional disabilities, and a higher level of academic achievement. When these variables were controlled, costs were lower on average for implanted compared with nonimplanted children for the subset of children whose AHLs exceeded 111 dB. At the mean AHL of the implanted children (115 dB), implantation was associated with a reduction of €3105 (95% confidence interval, €1105 to €5106) in annual education costs. Conclusions: Pediatric cochlear implantation is sufficiently effective to influence resource-allocation decisions in the education sector. The health-service cost of implantation is partly offset by savings in the cost of education. These savings occur without detriment to academic achievements. The provision of cochlear implants to young deaf children is a high-cost intervention in the domain of health care with the potential to save resources in other domains, including education. The finding that such savings arise would be a powerful demonstration of the effectiveness of implantation. This study estimated the cost of educating each member of a representative sample of more than 2000 hearingimpaired children in the United Kingdom, including 400 children with cochlear implants. Statistical control was exercised over variables that influence the cost of education in order to isolate the component of cost associated the use of an implant. In this way, implantation was estimated to be associated with savings amounting to €15,000-€40,000 over 12 years of compulsory education, with greater savings the poorer the pre-operative hearing level of the child. In the same sample of children, implantation was associated with better outcomes from education. Thus, the study demonstrates that implantation is sufficiently effective to save resources in education while simultaneously enhancing educational outcomes.