Economic Evaluation of Pediatric Cochlear Implantation: A Comparative Analysis by Age and Characteristics

Objective: To evaluate the economic burden of pediatric cochlear implantation and its influencing characteristics. Study Design: Cost-benefit study. Setting: Patient surveys at a tertiary center. Methods: This economic study, conducted from a societal perspective, examined children with congenital severe-to-profound sensorineural hearing loss who received either bimodal hearing (a hearing aid in one ear and a cochlear implant in the other) or bilateral cochlear implants. The analysis accounted for age at implantation and severity of hearing impairment. Costs included government expenditures on healthcare, social welfare, and education as well as family out-of-pocket expenses and productivity losses up to age 18. Quality-adjusted life years were derived from health-utility values of Taiwanese children using hearing devices, with a willingness-to-pay threshold set at one-time the gross domestic product per capita. Results from children using bilateral hearing aids served as a reference group for comparison. Results: Total cumulative costs per child were primarily driven by educational expenses. Among children with unilateral cochlear implants, early implantation demonstrated absolute dominance, yielding the highest net present value due to lower overall costs and substantial benefits. For children with bilateral cochlear implants, the net present value remained positive, indicating that the benefits of implantation continued to outweigh the costs in these groups. Conclusion: Cost-benefit analysis revealed a positive net present value in all cases, with a willingness-to-pay threshold set at one-time the gross domestic product per capita. From both medical and economic perspectives, early implantation is recommended for children with bilateral severe-to-profound sensorineural hearing loss.