PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1101-1112 (doi:10.1542/peds.2005-1335)
The Economic Costs of Congenital Bilateral Permanent Childhood Hearing Impairment
a National Perinatal Epidemiology Unit, Oxford, United Kingdom
b Department of Child Health
c School of Psychology
f Public Health Science and Medical Statistics, University of Southampton, Southampton, United Kingdom
d Institute of Child Health, University College London, London, United Kingdom
e Department of Audiology, Whipps Cross University Hospital, London, United Kingdom
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ABSTRACT |
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OBJECTIVE. The objective of this study was to estimate the economic costs of bilateral permanent childhood hearing impairment (PCHI) in the preceding year of life for children aged 7 to 9 years.
METHODS. A cost analysis was conducted by using a birth cohort of children born between 1992 and 1997 in 8 districts of Southern England, of which half had been born into populations exposed to universal newborn screening (UNS). Unit costs were applied to estimates of health, social, and broader resource use made by 120 hearing-impaired children and 63 children in a normally hearing comparison group. Associations between societal costs per child and severity of hearing impairment, language ability score, exposure to UNS, and age of confirmation were analyzed, including adjustment for potential confounders in a linear regression model.
RESULTS. The mean societal cost in the preceding year of life at 7 to 9 years of age was £14092.5 for children with PCHI, compared with £4206.8 for the normally hearing children, a cost difference of £9885.7. After adjusting for severity and other potential confounders in a linear regression model, mean societal costs among children with PCHI were reduced by £2553 for each unit increase in the z score for receptive language. Using similar regression models, exposure to a program of UNS was associated with a smaller cost reduction of £2213.2, whereas costs were similar between children whose PCHI was confirmed at <9 or >9 months.
CONCLUSIONS. The study provides rigorous evidence of the annual health, social, and broader societal cost of bilateral PCHI in the preceding year of life at 7 to 9 years of age and shows that it is related to its severity and has an inverse relationship with language abilities after adjustment for severity.
Key Words: cost analysis • universal neonatal screening • permanent childhood hearing impairment
Abbreviations: PCHI—permanent childhood hearing impairment • HL—hearing level • HOP—Hearings Outcomes Project • UNS—universal newborn screening • CI—confidence interval
Bilateral permanent childhood hearing impairment (PCHI) of 
40-dB hearing level (HL) can be expected to affect between 112 and 133 infants per 100000 births and 
840 cases per year in the United Kingdom.1,2 It has been suggested that the prevalence of PCHI increases substantially with age.3 The consequences of the condition include life-long impairment in language skills and possible delays in social development and academic achievement.1,4–6 The outcome is influenced by the degree and duration of hearing loss, the age at which the hearing loss first appears, and the hearing frequencies affected.3 It is also influenced, in some cases, by comorbidities, such as visual impairment, mental retardation, and cerebral palsy.3 Developmental delays are particularly apparent for children with severe and profound hearing impairment.7–9 Children with hearing impairment possibly also experience lower self-perceived health status than those without hearing loss.1,10 Early management of hearing impairment has been thought to provide benefit to these children, composed of improved communication and language ability, mental health, and future employment prospects.1,10
The economic consequences of hearing impairment in the neonatal period have already been reported,11 but not those occurring subsequently. We report here the economic costs of hearing impairment in the preceding year of life at 7 to 9 years of age. This study was undertaken as part of the Hearing Outcomes Project (HOP) in which the effect of exposure to universal newborn screening (UNS) and of age of confirmation of PCHI on language abilities in middle childhood was examined. The study provides information with the effect of these variables on total societal costs in the preceding year.
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METHODS |
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Trial Background and Study Population
Language and speech outcomes were assessed in children with bilateral PCHI
40-dB HL born in 8 districts of Southern England between the middle of 2002 and the middle of 2003. Children with a known postnatal cause (such as bacterial meningitis) were not included. A comparison group of children with normal hearing, matched with the group of children with PCHI for place of birth and age at assessment, was also evaluated. The normally hearing comparison group was chosen to be compared with the groups of children confirmed at 
9 months and >9 months and with those exposed or not exposed to a program of UNS. The HOP research team had estimated recruitment of 60 children into each of the 2 groups and, therefore, recruited a comparison group of the same size (CR Kennedy, D McCann, MJ Campbell, et al, unpublished data, 2005). The South and West Multicenter Research Ethics Committee approved this study, and participating principal caregivers provided written informed consent. Four of the districts (Southampton, Portsmouth, Swindon, and Bath) are in the Wessex region and provided a cohort of 54000 births in 4 maternity units over a 3-year period from 1993 to 1996. This group also formed the sample for the Wessex controlled trial of UNS for PCHI.12,13 The other 4 districts are in the London region and provided a cohort of 85000 births in those districts over a 5-year period from 1992 to 1997. In that period, 2 of these districts (Waltham Forest and Hillingdon) had and their 2 neighboring districts (Redbridge and Brent and Harrow) had not operated a program of UNS. Both of the London districts operating UNS had reported on its impact on the early diagnosis of PCHI and collected data prospectively in this birth cohort.14,15 In the case of Waltham Forest, this had been a prospective comparison with the Redbridge district. Thus, about half of the entire birth cohort of the present study had been in a target population for UNS for PCHI with >90% of the sample included from birth in prospective studies of PCHI. Outcomes measured at 7 to 9 years of age included language and speech abilities, behavior, and health status by means of a number of assessments reported in detail elsewhere (CR Kennedy, D McCann, MJ Campbell, et al, unpublished data, 2005; J Stevenson, DC McCann, P Watkin, S Worsfold, C Kennedy, on behalf of the Hearing Outcomes Study Team, unpublished data, 2005). The key measures of language were the Test of Reception of Grammar,16 British Picture Vocabulary Scale17 (receptive language), and the Renfrew Bus Story18 (expressive language). The research staff involved in the follow-up study was unaware of the age of initial referral and management and, in the case of the 4 Wessex districts, blind to whether or not the child was in the target population for UNS.
Resource Use Data
Two broad strategies were adopted to collect data about the use of resources for all of the children included in the study. First, parents were interviewed at home about the service use of their child over the previous year of life. The research instruments were developed by the HOP research team and piloted to ascertain their acceptability, comprehension, and reliability before face-to-face interviews with the parents. They were piloted and administered by 5 research assistants employed in the HOP study. The data collected from parents as part of the home interviews related to their child's use of hospital and community health services, social services, and education services. Time taken off work by parents over this period as a result of the child's ill-health and broader societal impacts that could be attributed to the child's disability, such as the installation of light-up telephones, deaf person's smoke alarms, and radio aids, were also measured. Second, identification of the number and type of audiology contacts, health professionals seen during these contacts, hearing aids provided, cochlear implants, and audiological equipment loaned over the previous year of life was undertaken by a retrospective examination of each child's audiology records. Visits to outpatient departments for audiological care were included as audiological contacts. The costs attributed to cochlear implants were annuitized over 60 years and discounted at 3%.
Unit Costs
Unit costs for resources used by the children who participated in the study were obtained from a variety of primary and secondary sources. All of the unit costs used followed recent guidelines on costing health and social care services as part of an economic evaluation.19–21 The calculation of these costs was underpinned by the concept of opportunity cost, which can be defined as the value of the next best alternative for using these resources.19–21 Secondary information was gathered from available published studies and ad hoc studies reported in the literature. The unit costs of community health and social services were largely derived from national sources22 and took account of time spent by professionals on indirect activities, such as traveling and paper work. Some unit costs of community health and social services were calculated from first principles using established accounting methods, which include salary, oncosts, capital overheads, and travel.23 Drug costs were obtained from the British National Formulary.24 Educational costs were obtained from the Department of Education and Skills.25 Loss of earnings because of work absences by the child's parent were valued using gender-specific median salaries provided by the New Earnings Survey, England.26 All of the costs were expressed in pounds sterling and valued at 2003 prices.
Data Analysis
The categories of severity of PCHI were defined as moderate (40- to 69-dB HL), severe (70- to 94-dB HL) and profound (95-dB HL) impairments with the 4-frequency degree of hearing loss in the better hearing ear averaged over the frequency range 500 to 4000 Hz. Although such descriptors of impairment do not assume a classification of functional disability in children, this can be inferred. All 3 degrees of PCHI have a serious impact on the child's ability to acquire communication skills, and hearing aids are required to access speech. Without hearing aids, those with a moderate degree of deafness hear only the loudest components of speech. Those with a severe or profound deafness have access to environmental sounds, and the preferred method of communication may be through a system of signed language.27 Cochlear implants are also available for those children with more severe impairments who are otherwise unable to access the different frequency components of speech with conventional hearing aids.
The proportion of the children whose PCHI was confirmed by 9 completed months of age was prespecified as the dividing point between the 2 categories of age of confirmation to provide consistency both with the research group's previous investigations of the efficacy of UNS in increasing "early referral" (by 6 months) and "early confirmation" (by 9 months)12 and also with the work of Yoshinaga-Itano et al,10 who reported substantial benefits to language associated with "early identification" (by 6 months) with "onset of ongoing intervention" (after a mean interval of an additional 3 months).
The use of z scores for language (and also for other outcomes reported elsewhere) made possible the derivation of the aggregate scores reported here {eg, z(receptive language) = [z(Test of Reception of Grammar) + z(British Picture Vocabulary Scale)/2]} (CR Kennedy, D McCann, MJ Campbell, et al, unpublished data, 2005; J Stevenson, DC McCann, P Watkin, S Worsfold, C Kennedy, on behalf of the Hearing Outcomes Study Team, unpublished data, 2005). To calculate the z score, the mean and SD of age-adjusted scores of the normally hearing children was calculated. The z score for a child with PCHI was equal to the number of SDs by which their score differed from the group mean score in the normally hearing children.
The social class variable was categorized according to occupation of the head of the household divided into higher, intermediate, and lower occupations and a 4th category of never worked and long-term unemployed.28 The resource use values were combined with unit costs to generate estimates of costs over the previous year of life. Two sets of analyses were undertaken. First, comparison was made between societal costs in the 3 grades of severity of hearing loss among children with PCHI and between these costs in all of the children with PCHI and the normally hearing group. These were expressed as mean differences in resource use and costs with 95% confidence intervals (CIs) where applicable. As the data for costs were skewed, in addition to Student's t tests of cost differences, nonparametric bootstrap estimation was used to derive 95% CIs for mean cost differences between the comparison groups.29 Each of these confidence intervals was calculated by using 1000 bias-corrected bootstrap replications.
Second, in children with PCHI but not in normally hearing children, the effects of language abilities, as measured by z score, of birth during a period of UNS and of confirmation of PCHI by the age of 9 months on annual societal cost during the preceding year of life were examined. For this purpose, estimates were both derived from the raw figures and also adjusted for confounding variables (listed in Table 5) in a multiple linear regression. All of the analyses were performed with a microcomputer using the SPSS 11.5.0 (SPSS Inc, Chicago, IL) software and Microsoft Excel 5.1.2600 (Microsoft Corporation, Seattle, WA).
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RESULTS |
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Study Population
A total of 168 hearing-impaired children were considered eligible for recruitment into the study, based on the study inclusion criteria (see "Methods"). Of these 168 children referred to the project team, 6 were not approached, because this was deemed inappropriate by their audiologist because of severe acute problems with their health at the time of recruitment, whereas 2 could not be traced. Of the remaining 160 children, 120 (75%) hearing-impaired children (67 boys and 53 girls) of mean age 7.9 years (range: 5.4–11.7 years) and their parents agreed to participate. Fifteen (9%) refused study participation, and 25 (16%) families did not respond. No statistically significant differences were found between participants and nonparticipants in age at the time of follow-up, gender, and severity of hearing loss. A group of 63 normally hearing children (37 boys and 26 girls) of mean age 8.1 years (range: 6.3–9.8 years) born at the same time and in the same hospitals over the 8 districts also agreed to participate.
The distribution of age at the time of follow-up, gender, social class, and mother's highest educational qualification were similar in the children with PCHI to that in the normally hearing group (Table 1). Sixty-five (36%) of the study participants had moderate PCHI, whereas 29 (16%) and 26 (14%), respectively, had severe and profound PCHI. Forty-nine (27%) of the study participants were assessed at <7 years of age, 99 (54%) between 7 and 9 years of age, and 35 (19%) at >9 years of age. Eighty-six (71%) of the 120 hearing-impaired participants used oral communication compared with 63 (100%) of the normally hearing children; 11 (9%) used a combination of oral and signing, 16 (13%) used signing as their main mode of communication, and 7 (6%) used nonverbal communication and gestures. Chromosomal and syndromal disorders, visual problems, and asthma had been identified in 23 (19%), 13 (11%), and 12 (10%) children with PCHI compared with 2 (3%), 1 (2%), and 5 (8%) of the normally hearing children, respectively. Cerebral palsy and learning disability had been identified in 5 (4%) and 8 (7%) of children with PCHI, respectively and in none of the normally hearing children. In general, the study participants were similar with respect to other baseline characteristics.
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Resource Use
Table 2 shows the use of health and social services for all 183 children in the study, as well as the broader resource impacts according to the severity of hearing impairment. Speech and language contacts were greater in children with profound than with severe PCHI (difference: 5 contacts; 95% CI: 0.0 to 52.0 contacts; P < .001) and greater in children with severe than with moderate PCHI (difference: 7 contacts; 95% CI: 0.7 to 12.7 contacts; P < .001). Children with severe PCHI had fewer audiology consultations than those with moderate PCHI. There were no significant differences in the number of general practitioner, physiotherapist, or social worker contacts between the severity groups, although the families of the profoundly hearing impaired children received substantially more social worker visits than did the severely hearing impaired children and less so the moderately hearing impaired children. Teachers of the deaf provided more hours of interaction to children with profound than to those with severe or moderate PCHI (profound: 20.3 days; 95% CI: 5.5 to 35; severe: 19.5 days; 95% CI: 4.2 to 34; and moderate: 16.5 days; 95% CI: 5.9 to 27, respectively; P = .007). There were no significant differences in the use of day care services, outpatient services, and other forms of care between the severity groups.
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Comparison of Cost Estimates Between Normally Hearing and Hearing-Impaired Groups
The estimates of resource use (Table 2) and of unit costs (Table 3) were combined to estimate the arithmetic mean societal cost for the entire hearing-impaired cohort at £14092.5 compared with £4206.8 for the normally hearing children (difference: £9885.7; 95% CI: 7729.4 to 11898.0; P < .001; Table 4). The mean cost for community and social care was £1368.2 greater (95% CI: 1115.6 to 1648.8; P < .001) for the hearing-impaired children compared with normally hearing children. Similarly, the mean cost in the preceding year attributable to lost productivity because of the health of the child was higher for the hearing-impaired cohort (difference: £116.1; 95% CI: 30.4 to 237.1; P = .05). The mean costs for educational services, including the significant cost driver of care provided by teachers of the deaf, were greater in the hearing-impaired children than the normally hearing children (difference: £7280.5; 95% CI: 5514.9 to 9377.4; P < .001; Table 4).
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Comparison of Cost Estimates Within the Hearing-Impaired Group
The mean societal costs (and cost differences relative to those of normally hearing children) varied by severity of PCHI as follows: £9120.5 (£4913.7) for moderate, £21178.9 (£16972.1) for severe, and £18294.9 (£14088.1) for profound PCHI (Table 4). Children with profound PCHI generated greater costs for annual visits to health professionals (£2320.5) when compared with severe (£1954.9) and moderately (£1189.4) hearing-impaired children (Table 4). Similarly, the costs born by parents were greatest in children with profound PCHI (£221.1) when compared with the severe (£154.9) and moderately (£61.4) impaired children (P = .05). Cochlear implants resulted in significant costs in 13 children, of whom 4, 1, and 8, respectively had moderate, severe, and profound PCHI. The mean costs of hearing-impaired children with and without implants were £21555 (95% CI: 5498.9 to 57904.2) and £13202 (95% CI: 4095.3 to 37600.7), respectively.
The presence of a significant medical condition in addition to PCHI (27 children) was included as a potential confounder in the multiple regression, thereby allowing for a disaggregation of their effect on total costs. When the cost estimates in these children were excluded from the analysis, the reduction in the arithmetic mean societal cost was £578.3, £2659.8 and £746.1 per annum, respectively, for children with moderate, severe, and profound PCHI and £1371 for these severity groups combined.
Effect on Cost in Children With PCHI of Language Skills, UNS, and Age of Confirmation
We have reported significant effects of exposure to UNS and of confirmation of PCHI by 9 months on language abilities (CR Kennedy, D McCann, MJ Campbell, et al, unpublished data, 2005). If the effects of UNS or of early confirmation also resulted in a reduction in costs in middle childhood, this would be likely to be mediated by an improvement in language abilities and we, therefore, first looked at the relationship between language abilities and cost. Unadjusted total costs during the preceding year, averaging £14092.5 in all children with PCHI (see above), were lower for each unit increase in the z score for receptive and expressive language by £2815.3 (n = 104; 95% CI: 1648.5 to 3982.1; P < .001) and £2196.2 (n = 88; 95% CI: 777.1 to 3615.4; P = .003), respectively.
Unadjusted total costs during the preceding year in children with PCHI were lower in those who had been born with a program of UNS in operation at their place of birth at £12955.6 compared with £15267.2 in those born without a program of UNS in operation (difference: £2311.6; 95% CI: –1972.9 to 6606.2; P = .29) and were higher in children whose PCHI was confirmed by the age of 9 months at £14740.3 compared with £13505.3 in those whose PCHI was confirmed at a later age (difference: £1235; 95% CI: –3052.1 to 5522.3; P = .02; Table 4 and Figs 1 and 2). When differences in the various components of the total unadjusted costs (inpatient services, household expenses, medication, and total hospital and day care) were examined, no significant differences were found (Table 4).
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To examine further the effects of language abilities, UNS, and early confirmation on costs, we then adjusted for severity of PCHI for nonverbal ability score, for the presence of other significant medical conditions, and for social class. In this regression model, each unit increase in the z score for receptive language was associated with a mean reduction in total costs in the preceding year of £2553 (robust 95% CI: 667 to 4438; P = .001; Table 5). A smaller £1043 cost reduction (robust 95% CI: – 201 to 3007; P = .086) was seen for each unit increase in expressive language ability (data not shown in Table 5). Although we included them, neither the presence of medical problems nor variation in nonverbal ability had a significant effect on costs in any of the 3 regression models (Table 5).
To adjust for potential confounders in estimating the effect of UNS or the effect of confirmation by 9 months on costs, we replaced receptive language in the regression model described in the preceding paragraph by whichever of these 2 variables was being examined. Exposure to a newborn screening program was associated with a decrease in total costs in the preceding year by £2213.2 but with wide confidence intervals (95% CI: –6458 to 2 031.7; P = .30). In this model, the additional annual societal costs of care adjusted for other confounders, when compared with the costs in children in the "reference condition" of moderate PCHI were £11743 (95% CI: 6458 to 20317; P < .001) and £8955.3.1 (95% CI: 3487.1 to 14423.5; P = .002) for children with severe and profound PCHI, respectively. The adjusted cost in children with confirmation of PCHI by 9 months of age was not significantly altered from that in children with later confirmed impairments, being marginally higher (difference: £370.7; 95% CI: –3884 to 4626.2; P = .86; Table 5).
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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The study reported in this article shows reliably that there are substantial increases in costs at 7 to 9 years in children with PCHI compared with those with normal hearing and that severity of hearing loss is an important predictor of societal costs in the preceding year of life. Costs were also inversely related to receptive language abilities after adjustment for potential confounders.
The study adopted a broad, societal perspective and, thus, allowed for the measurement of health and social care costs, educational costs, direct nonmedical costs (eg, travel and child care costs), and indirect costs (eg, lost productivity). The study provided a vehicle for collecting a broad set of resource use and health-related outcome data. The quality of the data derived from parental questionnaires was generally very good with little missing data. Moreover, the study cost accounting was rigorous and included all significant health, social service, and broader societal cost items. The demonstration of the effect of PCHI and of language skills on societal costs was strengthened by adjustment for the potential confounding effect variation in severity of hearing impairment, nonverbal ability, and social class and the presence of comorbid medical conditions.
Only semiquantitative assessment of expressive British sign language was available, and the absence of a reference range for signing ability in children with normal hearing precluded calculation of z scores. This meant that the scores in 6 children who had only sign language assessments could not be included with the assessments of oral language included in the first regression model presented in Table 5. We were, therefore, unable to look for a possible reduction in costs associated with higher language scores in those children who communicated only by sign language.
The data that were collected were limited to the previous year because of concerns about parent's ability to recall health and community service use accurately. However, separate sensitivity analyses conducted by the authors revealed that varying levels of recall of resource use had no significant effect on the base case estimates (data available on request).
The researchers were unaware of the age at implantation of cochlear implants, and this may have resulted in an undervaluation of the costs of implantation, which can be considerably higher in the first year after implantation and may, therefore, have occurred within the time frame of our analysis.30
It is surprising that the mean cost estimated for the profound PCHI group was less than that for the severely impaired group, and this merits additional research. This finding might stem from the fact that the mean education costs were higher for children with a severe loss than for children with a profound loss. This result is likely to have arisen because a greater proportion of children with a profound loss (85%), compared with children with a severe loss (76%) were reported to attend mainstream school (Table 2). The provision of a cochlear implant has been estimated previously to be associated with a reduction in education costs,31–33 and this finding is consistent with our results.
The study confirms earlier findings that suggest that students with hearing impairment have more frequent physician visits.34 Previous studies have also noted that hearing impairment may contribute to an increased risk of other health conditions, which may have resource implications.35,36 Wolman37 found that deafness is among the most costly of disabilities in terms of educational resource provision and that deaf persons are more likely to be unemployed or underemployed than their hearing counterparts. This study corroborates findings that educational costs are higher for children with hearing impairment, although lower for children with disability and other special needs where the annual cost per pupil tends to vary between £13310 and £32859.25,38 Similarly this study finds that the costs to the family of caring for a hearing-impaired child are lower than the cost to families of caring for disabled children, which has been estimated at £7355 per annum.39
Because early intervention is the likely pathway linking early confirmation to benefits to speech and language and, thus, to a possible reductions in costs, the poor definition of the pathways of care and variable transition to early intervention after early confirmation for the children in our sample is a significant limitation of the study. The demand for such pathways arose in the early 1990s in the United Kingdom largely because of the introduction of UNS, pioneered in the sample reported here, and the resulting increase in the numbers of children whose PCHI was confirmed early in infancy.13–15 This study was not able to show reliably that either early confirmation of hearing impairment or exposure to screening were important in reducing societal costs in middle childhood, but this effect may have been underestimated in this sample because of variability in their care compared with the benefit that might be seen in a current birth cohort for whom pathways of care are better established in the United Kingdom.14 Furthermore, the cost data available to the HOP research team was cross-sectional rather than longitudinal, thus limiting the team's ability to perform comprehensive cost-effectiveness analyses or lifetime cost analyses.
We and others 40,41 have hypothesized that language impairments will be associated with increased costs to society and, second, that the benefit to language skills associated with UNS will reduce these costs. The estimated significant £2552.6 decrease in societal cost per unit increase in the language score supports the first hypothesis. Support for the second hypothesis was weaker in that the 95% CI for the mean adjusted £2213 reduction in these costs over 12 months for children with PCHI born in periods with UNS, compared with those born in periods without UNS, included a null value. We would expect the correlation between birth in periods of UNS and improved language skills in middle childhood to be higher in a present day birth cohort because of better present day definition of and adherence to pathways of care after UNS.
The best estimate of a £2213 reduction in costs in the preceding year associated with UNS provides a basis for comparing the potential of UNS for reducing costs in middle childhood with the reported costs associated with UNS in the newborn period. Reports of the latter costs have been similar in the United Kingdom (£13881 in 1994)11 to those in the United States ($25000 in 1996)40 per 1000 births. The United Kingdom figure, adjusted for inflation according to the NHS Hospital and Community Health Services Pay and Prices Index, is equivalent to £18482 at 2003 prices. The Preventative Screening Task Force estimated the number of infants needed to screen to diagnose 1 case of PCHI to be 584.40 Applying this figure to the updated estimates of neonatal costs suggests a neonatal cost of UNS of £10793 (2003 £ sterling) per case of PCHI identified. The present study, therefore, suggests that the best estimate of the annual cost saving of UNS in middle childhood is 21% (2231 of 10793) of the neonatal cost of UNS per child with PCHI in the United Kingdom. If such an annual cost saving were generalizable across other years of the child's school life, this would add an economic argument to the health argument in favor of UNS.
The total annual economic burden of care for 840 hearing-impaired children in the United Kingdom at 7.9 years of age based on the cost estimates in this study could be estimated at anywhere between £4127508 and £14256564, with the average total cost approximately £8303988 per annum. It is clear from the study that hearing-impaired children require greater use of community and social care services (such as speech and language consultations, audiology appointments, and social worker visits) and that the costs associated with hearing impairment are largely driven by costly education services, adaptations to housing required by children with multiple medical disabilities, and lost productivity by parents attributable to their child's state of health.
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CONCLUSIONS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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The study provides rigorous evidence of the costs attributable to bilateral moderate, severe, and profound permanent hearing impairment and the influence of verbal ability, exposure to screening, and age of confirmation of hearing impairment on those costs and provides long-term economic information to decision makers as they consider allocating resources in an important area of health care. It is incumbent on decision makers to decide how the study results affect the provision of audiology and other services for children with hearing impairment.
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ACKNOWLEDGMENTS |
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We thank Sue Robinson for her contribution to the study and help in the preparation of this article.
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FOOTNOTES |
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Accepted Sep 20, 2005.
Address correspondence to Liz Schroeder, MSocSc, National Perinatal Epidemiology Unit, University of Oxford (Old Road Campus), Old Road, Headington, Oxford OX3 7LF, England. E-mail: liz.schroeder{at}npeu.ox.ac.uk
The authors have indicated they have no financial relationships relevant to this article to disclose.
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