A PROSECTIVE STUDY ON COSTS TO INSURANCE AND OUT-OF-POCKET COSTS OF COCHLEAR IMPLANTATION COMPARED WITH HEARING AIDS IN NEWLY IMPLANTED ADULT RECIPIENTS

Purpose: Cochlear implantation(CI) is the standard of care for the treatment of children and adults with bilateral severe to profound sensorineural hearing loss. However, costs may be a barrier to more widespread use of CIs despite being shown as cost-effective, with significant impact on quality of life. Our objective is to compare the insurance-based and out-of-pocket costs of CI compared with hearing aids (HA) in adult CI recipients.

Method: A prospective multicenter study using the Patient based resource use and expenditure (PBRUEQ) questionnaire to evaluate self reported outcomes and total utilization and costs 6 months before and during and 6 months after CI. Subjects (N=28) were bilateral severe to profound sensorineural hearing impaired adults who were evaluated for a Cochlear "Nucleus" CI system. The PBRUEQ was administered at baseline and 6 months post CI. National 2010 costs were used. Costs included devices, batteries, device upkeep, MD and hospital visits, surgery, adverse effect treatments, procedures, hearing support personnel and devices and work and time losses for care. Analysis is total insurance-based and out-of-pocket costs, and t-tests to compare pre and post costs.

Result: Average expenditure for CI and 6 month costs after CI was $74,979 compared to HA and 6 month care prior to CI which was $6,051(n=15-28). Insurance paid more for CI (94%) than for HA (26%). Out-of-pocket costs was still 3 times higher for CI than for HA ($4,494) despite being only 17% of total costs for CI as opposed to 74% of total for HA's. 89% reported improved QOL. There were significant increases in work time and efficiency post CI resulting in economic gains of $1,213 and $4,187 (n=15-28) per 6 months respectively.

Conclusion: In the short term, and with this relatively small sample, CI is more costly than HA alone; however there are significant gains in self perceived benefits with the use of CIs. Most hearing aid expenses were self paid, while most cochlear implant expenses were paid by insurance. The 6 month work-related gains after CI implant offset the CI costs somewhat, and this would increase over time.