การประเมินเทคโนโลยีการผ่าตัดฝังประสาทหูเทียม : มุมมองด้านเศรษฐศาสตร์และสังคม

Abstract

Hearing loss leads to a loss of communication though speech with most people and an inability to develop social relationships with other people. This leads to an acceptance of a lower standard of quality of life. Parents or families are often concerned whether their loved ones will be able to depend on themselves. Most families are willing to trade their assets for a better life for their child. Cochlear implantation has been one of the most popular technologies that can correct hearing ability and lead to language development and good communicative skills. However, this intervention is very expensive and only a small amount of people have access to this technology. At present, one out of the three health schemes covers the cost of cochlear implant devices. To ensure equity among Thai people, a cost-effectiveness study of cochlear implantation is very important for policy-makers to make decisions regarding this expensive technology and to benefit those who need them. The purposes of this study are to estimate cost-utility of providing cochlear implantation compared to a ‘do nothing’ strategy, i.e. providing no intervention to bilateral profoundly deaf individuals, to assess the knowledge, anticipation and acceptance of deaf people and their families, and to evaluate the feasibility of cochlear implantation and rehabilitation services in Thailand. A model-based economic analysis using a decision tree was constructed to estimate the costs and Quality-Adjusted Life Years (QALY) gained from providing unilateral cochlear implantation and rehabilitation services for eligible profoundly deaf people, namely 1) prelingual deaf children, 2) prelingual deaf adults and 3) postlingual deaf adults with a decision tree model. Most input parameters were obtained from the Thai context through data collection from patient charts, hospital charges, and the Central Office for Healthcare Information, the focus group and interviews. Only utility data was derived from systematic reviews and meta-analyses of international published literature. The economic evaluation was conducted using both provider’s and the societal viewpoint. A probabilistic sensitivity analysis (PSA) was carried out to analyze the uncertainty of input parameters. The feasibility of cochlear implantation and rehabilitation services and the acceptance of this technology were received from interviews of experts in this field and focus group interviews of cochlear recipients (or their parents) along with deaf groups. The results show that providing cochlear implantation for prelingual deaf children is costeffective using the provider’s perspective that considers only cochlear implants, the surgical and rehabilitation process. However, if we take the burden that recipients have to bare (maintenance costs) into account, cochlear implantation is found to be not cost-effective in every group of recipients. For the social aspect, deafness and hearing loss affects one’s quality of life and social independence, especially those who have had a sudden loss of hearing. For children, hearing loss has brought concern to their parents. Moreover, the information of cochlear implantation, especially technological limitations, for example hearing and speaking ability after implantation, or long term care of cochlear and related tools and time and money that will be spent for the rehabilitation process, have not been delivered to recipients and families entirely. Parents and recipients most likely have received this information after the implantation. This causes misunderstanding and a misrepresentation of true results from this technology.