Evaluation of cost data associated with pediatric cochlear implantation (CI) throughout 2016-2021

David Z Allen; Gianna L Rosamilia; Kyung Hyun Lee; Zhen Huang

doi:10.1016/j.amjoto.2023.103790

Evaluation of cost data associated with pediatric cochlear implantation (CI) throughout 2016-2021

Am J Otolaryngol. 2023 Mar-Apr;44(2):103790. doi: 10.1016/j.amjoto.2023.103790. Epub 2023 Jan 20.

Authors

David Z Allen¹, Gianna L Rosamilia¹, Kyung Hyun Lee², Zhen Huang³

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America.
² Center for Clinical Research & Evidence-Based Medicine, University of Texas Health Science Center, Houston, TX, United States of America.
³ Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America. Electronic address: zhen.j.huang@uth.tmc.edu.

PMID: 36706716
DOI: 10.1016/j.amjoto.2023.103790

Abstract

Introduction: Cochlear Implants (CI) are a mainstay in the treatment of severe sensorineural hearing loss with proven cost-effectiveness and improved quality of life. However, costs associated with CI are variable. During the Covid-19 pandemic, elective surgeries decreased. The investigation into how the pandemic affected CI procedures, costs, and demographic utilization has not been elucidated.

Methods: A retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 50 children's hospitals, was performed. Regions were defined according to PHIS guidelines. We evaluated number of CIs, total charges and costs, Charge to Cost Ratios (CCR), demographic information, and subgrouped this analysis by region throughout 2016-2021. Charges were adjusted by CMS wage index for hospital location.

Results: During the years of 2016-2021, there was a rising number of CIs every year except for 2020 which had a decrease, largely driven by the southern and midwestern regions. The median number of cases did not differ between the years. The median adjusted charges increased every year, but not significantly ($103,883-$125,394). The median CCR also did not differ throughout the years (2.7-3.1). Still, there was a larger interquartile range in 2021 (2.3-4.4) for the median CCR compared to all other years (2.1-3.8), particularly in the South. The percentage of white, non-Hispanic/Latino patients who underwent CI was larger in 2020-2021 (78-79.8 %) compared to 2016-2019 (73.3-77.5 %).

Conclusions: The number of CIs in 2020 was lower than in 2019 or 2021. The median CCR for CI procedures increased from 2016 to 2021 but not significantly. The range of CCR was larger in 2021 compared to the years prior, suggestive of cost shifting by some hospitals to offset the loss in revenue. There was a small but significant increase in white, non-Hispanic patients receiving CI in 2020 and 2021, suggestive of a socio-economic shift in care post pandemic.

Keywords: Cochlear implant; Cost to charge ratio; Covid-19; Demographics; Otology; Pandemic.

MeSH terms

COVID-19* / epidemiology
Child
Cochlear Implantation* / methods
Cochlear Implants*
Cost-Benefit Analysis
Humans
Pandemics
Quality of Life
Quality-Adjusted Life Years
Retrospective Studies