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S44 Support & aftercare in assistive listening devices growing populations
Cochlear implantation-what it takes to sustain & maintain?
Mohandas N.D. , Kirtane M.V.
P D Hinduja National Hospital & Medical Research Centre, ENT, Mumbai, India, 2Hinduja Hospital, ENT, Mumbai, India
Introduction: This study aims to investigate the costs associated with cochlear implantation in India by means of
a phone survey, including not only the costs of procuring the implant but also the costs associated with
maintaining the device post-surgery.
Methods: A structured telephonic interview was administered to parents of pediatric recipients or recipients
themselves (>18 years old).The interview was divided into 4 sections. 1.Demographic data 2.Costs related to
procuring the implant, surgery and post-operative audiology and therapy 3.Costs associated with maintaining the
device 4.Satisfaction and planning for future expenditure. This interview was performed at. Hinduja
Hospital,Mumbai,India by an audiologist & took about 20 minutes to complete.100 randomly selected recipients
implanted between 1996-2007 were taken. A cut-off date of 2007 was applied to restrict data collection to
recipients with at least 5 years of device usage & therefore out of warranty for their external device.
Results: Out of the 100 very few were completely self-funded, rest were either completely or partially funded
through loans, mortgages, employer/company assisted, individual donors or with financial assistance from
relatives and friends. Other costs borne by the recipients for audiological, radiological tests, hearing aid trial &
training, surgery, mapping & habilitation (3 years post surgery), upgrades, batteries & chargers, coils & cables,
microphones & servicing & repair of processors was found out. The total average expenditure borne by a
recipient, excluding the cost of implant and surgery was found to be Rs.4,60,586(US $7489).
Discussion: In our experience we have found that many patients obtain sufficient funding for the initial device
and surgery, but forget to consider the ongoing expenditure post-implantation.
Conclusion: These results will enable us to counsel patients about the expected expenditure from pre-operative
to post-implant management. Clinicians clinics,patients,Government departments & donating agencies should
understand the long term expenses related to implantation. This information should help families to budget the
total expense not just for a CI surgery but also post implant mapping, therapy, servicing of implant, maintenance
of device, as well as to upgrade their device when new technology is available. This is particularly crucial in a
self-funded market and/or when the average wage is low in relation to the cost of intervention.
Learning outcome: As a cochlear implant is a lifelong commitment, patients must also be able to maintain the
device post-implantation & be counseled on appropriate maintenance & post-operative costs in addition to the
costs of the initial implant procedure. Hence this survey aimed to collect data on actual costs and breakdown of
these costs incurred by recipients/families in the 5 or more years since their surgery.
This information will be vital to counsel current and future recipients and to allow them to budget appropriately.