บทคัดย่อ
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.
