Long-term cost implications for cochlear implant recipients

Kerr, Gillian Robyn (2011-12)

Thesis (MAud)--University of Stellenbosch, 2011.

Thesis

ENGLISH ABSTRACT: Cochlear implantation is an expensive but cost-effective intervention which must be used for life. It can provide individuals with severe-to-profound hearing loss improved sound perception in comparison to that obtained using hearing aids. In South Africa implants are not state subsidised, and related costs need to be covered by implant recipients. Cochlear implant teams thus need to ensure that individuals, who are selected, will benefit from the device and will be able to use it for their lifetime. Implantees should know the immediate and potential future costs involved, to be able to decide on its affordability. The primary aim of this study was to determine the immediate and long-term costs of cochlear implantation. One hundred and fifty four implant recipients from the Tygerberg Hospital- University of Stellenbosch Cochlear Implant Unit in Cape Town, South Africa were surveyed. Costs were categorized according to the time period post implantation and were converted to Constant Rands (June 2010) using the Consumer Price Index to allow for comparison in real terms over time. In the first 10 years of implantation the average estimated costs incurred by adult implantees totalled R379 626, and children R455 225. The findings showed that the initial purchase of the implant system was the most substantial cost involved (currently R221 000). Upgrading the speech processor, which on the average took place every 7 years, was the second highest cost subjects encountered (currently R85 000). The cost of spares (on average R276 per year) and repairs (R3000 per repair) increased with duration of use. Battery costs ranged between R1200 and R3372 per year and insurance costs averaged R4040 per year. Most appointments took place in the first two years following implantation. Average travel costs during the first two years were R1024 for those within 50km of the implant unit and R8645 for those living more than 1000km away. Accommodation costs for non-local recipients, peaked during this period (on average R3390). Additional rehabilitation services for paediatric implantees cost an estimated R37 159 in the first five years after implantation. Subjects advised potential implantees to save, budget and plan for the high costs involved in implantation, as well as to join a medical aid which could assist with the costs involved. The findings of the study hold great relevance for both implantees and cochlear implant professionals. Careful consideration of the financial implications of cochlear implantation is critically important in the South African context to ensure that recipients are successful longterm cochlear implant users. Although the actual costs in the study were related to the one implant system used at Tygerberg Hospital-University of Stellenbosch Cochlear Implant Unit, it is believed that the types and amounts of costs involved hold relevance for all individuals implanted in South Africa.

AFRIKAANSE OPSOMMING: Kogleêre inplantering is ‘n duur maar koste-effektiewe prosedure wat lewenslank gebruik moet word. Dit verskaf aan individue met erge-tot-uitermatige gehoorverlies verbeterde klankpersepsie in vergelyking met dié wat gehoorapparate gebruik. In Suid Afrika word kogleêre inplantings nie deur die staat gesubsidieer nie en koste moet deur die inplantgebruiker verhaal word. Kogleêre inplantingspanne moet gevolglik verseker dat individue wat geselekteer word daarby baat sal vind en lewenslank sal kan gebruik. Inplantgebruikers moet bewus wees van die onmiddelike, sowel as langtermyn onkoste. Die primêre doel van hierdie studie was om die onmiddelike en langtermyn onkoste van implanterings te bepaal. Een honderd vier en vyftig inplantgebruikers van die Tygerberg Hospitaal-Universiteit Stellenbosch Kogleêre Inplantingseenheid in Kaapstad, Suid Afrika is gebruik vir die studie. Onkoste was gekatogoriseer ten opsigte van die periode van tyd postinplantering en dit is omgeskakel na konstante Randwaarde (Junie 2010) deur die Gebruikers Prys Indeks te gebruik sodat vergelykings gemaak kon word in reële terme oor tyd. Gedurende die eerste 10 jaar na inplantering was die geskatte onkoste by volwasse inplantgebruikers R379 626 en by die pediatriese groep was dit R455 225. Bevindings het aangedui dat die aanvanklike aankoop van die inplantsisteem die grootste onkoste behels het (huidig R221 000). Opgradering van die prosesseerder, gemiddeld elke 7 jaar, was die tweede hoogste onkoste, naamlik R85 000. Die gemiddelde koste van spaaronderdele was R276 per jaar. Herstelkoste het R3000 per herstelling beloop. Koste van spaaronderdele en herstelkoste het met duur van gebruik vermeerder. Batteryonkoste het gewissel tussen R1200 en R3372 per jaar. Onkoste van jaarlikse versekering was gemiddeld R4040. Meeste afsprake het gedurende die eerste twee jaar plaasgevind. Vervoeronkoste gedurende hierdie periode was R1024 vir die wat binne 50km woon en R8645 vir dié meer as ‘n 1000km ver. Akkommodasie koste het ‘n piek gedurende hierdie periode bereik (gemiddeld R3390). Addisionele rehabilitasie dienste vir pediatriese inplantgebruikers was gemiddeld R37159 gedurende die eerste vyf jaar. Die proefpersone het aanbeveel dat potensiële inplantgebruikers moet spaar, begroot en beplan vir die hoë onkoste en is aanbeveel om aan te sluit by ‘n mediese fonds. Die bevindinge van die studie is van belang vir beide ontvangers sowel as inplantingspanne. Bewusmaking van die finansiële implikasies van kogleêre inplantering is van kritiese belang om suksesvolle langtermyn gebruik te verseker. Alhoewel die werklike onkoste in die studie van toepassing is op een inplanting sisteem wat by Tygerberg Hospitaal-Universiteit Stellenbosch Kogleêre Inplantingseenheid gebruik word, kan dit aangeneem word dat die tipes en hoeveelheid onkoste van toepassing is op alle individue in Suid Afrika wat kogleêre inplantings ontvang.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/17952
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