Hearing Loss And The Financial Advantage Of Cochlear Implantation
Overview
The study aimed to estimate the costs associated with severe to profound hearing loss (SPHL) throughout a person’s life, including the financial impact and potential savings related to cochlear implantation. Data for the analysis were sourced from the National Health Interview Survey, the National Health and Nutrition Examination Survey, and national Medicare rates. To model the costs over a lifetime, the researchers employed continuous time state transition models with individual patient simulations. These models considered four distinct health states: normal hearing, severe to profound hearing loss, cochlear implantation, and death.
The findings indicated that the estimated lifetime cost for an individual born with severe to profound hearing loss is approximately $489,274, with a range between $377,518 and $616,519. Notably, individuals who received a cochlear implant before 18 months of age faced lower lifetime costs, around $390,931, compared to those who did not receive an implant, whose costs were estimated at $608,167. For those experiencing hearing loss later in life, such as at 60 years of age, the estimated lifetime cost was significantly lower, at $154,536.
On a broader scale, the annual societal costs for the U.S. population were estimated to range from $8 billion to $187 billion, with an average of $37 billion. The study concluded that severe to profound hearing loss imposes substantial financial burdens, primarily due to lost productivity. Although cochlear implantation increases medical costs, these are offset by higher earnings due to improved hearing, ultimately resulting in reduced lifetime costs. The study underscores the importance of early access to hearing healthcare and technology, highlighting the positive effects on language development, education, and overall quality of life. The researchers advocate for policy changes to improve access and coverage for hearing technology, which could lead to a reduction in both lifetime and societal costs.
Introduction
Hearing loss is the most prevalent form of sensory impairment globally, affecting approximately 430 million individuals, including 34 million children. Currently, around 5% of the global population experiences disabling hearing loss, a figure that rises sharply to 25% among those over 60 years old. The World Health Organization predicts that by 2050, 2.5 billion people will experience some degree of hearing loss, with 700 million likely to require hearing rehabilitation. Hearing loss can vary from mild to profound, with more severe cases necessitating greater intervention. Current statistics indicate that 30.7 million people worldwide suffer from severe hearing loss, while an additional 17.2 million experience profound hearing loss.
In the United States, it is estimated that 1.77 million people have severe bilateral hearing loss, and 0.35 million suffer from bilateral profound hearing loss. The impact of hearing loss is extensive, affecting communication, educational achievement, employment opportunities, social interactions, emotional well-being, and overall quality of life. The global economic burden of unaddressed hearing loss is estimated at $980 billion annually, including costs related to education and lost productivity. Accurate cost estimates for severe to profound hearing loss (SPHL) have been limited due to incomplete data on the incidence of SPHL, the impact on earning potential, and comprehensive accounting of medical expenses.
As the criteria for cochlear implantation continue to expand, there is a growing need for research on the societal costs and cost-benefits associated with hearing technologies like cochlear implants (CIs). In the United States, cochlear implantation is the standard treatment for bilateral severe to profound hearing loss, offering long-term benefits in language development, academic performance, and quality of life. However, access to and coverage for cochlear implants varies significantly depending on geographic location and health insurance policies.
The primary objective of the current study was to estimate the lifetime costs and societal impact of severe to profound hearing loss using contemporary national data sources. A secondary objective was to model the potential cost savings associated with cochlear implants on overall societal costs.
Methods
This study conducted an extensive analysis of the costs associated with severe to profound hearing loss (SPHL), which stem from three primary areas: diminished work productivity due to delayed entry into the labor market, underemployment, and unemployment; the need for specialized educational resources; and medical expenses. The research employed multiple data sources and simulated patient life histories to provide a comprehensive cost estimation. The study received approval from the University of Miami Institutional Review Board (Protocol #20201102).
Data Sources:
The study utilized a variety of data sources to estimate the incidence of severe to profound hearing loss, along with associated medical, educational, and income costs. These sources included national and government databases as well as published research. The incidence of severe to profound hearing loss was estimated using data from the National Health and Nutrition Examination Survey (NHANES) collected between 2017 and March 2020, which included audiological evaluations and reported the onset of hearing loss. Income estimates were derived from both the National Health Interview Survey (NHIS) and the 2017–2018 NHANES. Educational costs were estimated based on the Individuals with Disabilities Education Act, which recommends allocating twice the cost per pupil for public education, using 2019 data. Medical and audiological costs were estimated using the 2021 national Medicare rates. These data sources were chosen for their comprehensive and nationally representative estimates of prevalence, incidence, and associated costs. Additionally, mortality data were obtained from the 2019 National Center for Health Statistics, and information on the incidence of SPHL identified through newborn screening was sourced from the 2019 CDC Vital Statistics.
Also read Difficulty With Hearing And Blood Pressure In Geriatric Adults
Analysis
To estimate the lifetime costs of severe to profound hearing loss (SPHL), we employed continuous time state transition models with individual patient simulations. The model encompassed four states: normal hearing (NH), severe to profound hearing loss, cochlear implantation (CI), and death, with time-dependent transition probabilities estimated for movement between these states. Uncertainty in both transition and cost models was addressed by performing 1,000 random draws from the sampling distributions of the survival and regression models. These simulations were executed for 100,000 participants over a 100-year period using the R package.
The model incorporated time-dependent yearly costs for severe to profound hearing loss and cochlear implantation states, mapped onto each simulated life history based on specific age groups for special education (≤ 18 years) and income (18–30; 30–45; 45–65; 65+). Additionally, medical costs were calculated relative to NH, considering age and the number of years since transitioning into the SPHL and CI states. We constructed 95% confidence intervals around the estimates using the 5th and 95th percentiles of the random draws. All cost estimates were discounted at a rate of 3.9%, and the figures were expressed in 2018 dollars, reflecting the year of the NHIS data used in the analysis. An expected inflation rate of 2.3% was applied to both future costs and compensation. Results from sensitivity analyses, including tornado plots, are provided in the supplementary materials.
Results
This study utilized data from the 2017 to March 2020 NHANES to model the transition between normal hearing (NH) and severe to profound hearing loss (SPHL). The analysis included 4,579 participants who completed audiological exams. We excluded those with significant discrepancies in test results and assigned a threshold of 125 decibels to participants who did not respond to the highest stimulus level. Hearing status was determined using the pure-tone average for the best ear, classified according to WHO criteria into categories ranging from normal to profound hearing loss. A total of 68 participants exhibited severe or profound hearing in their best ear. To model transition rates, a parametric survival model with a Weibull distribution was used, adjusted for the survey design through survey weights and Taylor series linearization. The model underestimated SPHL diagnoses at birth, so data from the 2018 Early Hearing Detection and Intervention Program was included to supplement this information.
Transition to cochlear implantation (CI) was set to occur one year after severe to profound hearing loss onset, with transition rates of 0.55 for youth and 0.07 for adults, based on CI penetration rates. Death rates were estimated using the 2019 CDC National Vital Statistics Report and modeled using a Weibull distribution. The death rates were assumed to be consistent across NH, SPHL, and CI states.
For estimating lost productivity, data from the NHIS were used. This dataset provided nationally representative information on demographic, socioeconomic, and health characteristics, including hearing status. Individuals reporting significant hearing difficulties were classified as having severe to profound hearing loss. The analysis revealed that individuals with severe to profound hearing loss in the U.S. consistently earned less across all age groups, with the most substantial gaps in earnings observed in the 18-30 and 30-45 age groups. Employment rates were also lower for those with SPHL, particularly in the 45-65 age group.
Educational attainment was identified as a key factor influencing labor market outcomes for individuals with severe to profound hearing loss. The study found lower levels of educational attainment among those with SPHL, with a significant gap in college completion rates between individuals with and without severe to profound hearing loss, especially among those aged 30-45.
Special education costs were estimated using a conservative approach, equating them to twice the average national per-pupil cost of public education as per the Individuals with Disabilities Education Act (IDEA). The study utilized the 2019 Public Elementary-Secondary Education Finance Data to estimate these costs.
Conclusion
In summary, severe to profound hearing loss (SPHL) presents significant financial burdens and impacts on educational and workforce outcomes. The findings of this study contribute to the growing body of evidence highlighting the benefits of cochlear implants (CIs) and underscore the importance of early detection and intervention. This information is vital for policymakers and hearing health professionals, demonstrating the potential for cost savings through timely identification and treatment. Otolaryngology and audiology practices must enhance their outreach efforts and expand access to CIs to increase penetration rates and improve patient outcomes. Collaborative efforts with communities, early intervention programs, and legislators are essential to promoting early intervention, enhancing children’s language development, and improving their quality of life, which in turn will yield substantial societal benefits.
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