Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.

Publication ,  Journal Article
Emmett, SD; Tucci, DL; Smith, M; Macharia, IM; Ndegwa, SN; Nakku, D; Mukara, KB; Ibekwe, TS; Mulwafu, W; Gong, W; Francis, HW; Saunders, JE
Published in: Otol Neurotol
September 2015

HYPOTHESIS: Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. BACKGROUND: Cost effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where access to the technology has traditionally been limited. With incidence of severe-to-profound congenital sensorineural hearing loss 5 to 6 times higher in low/middle-income countries than the United States and Europe, developing cost-effective management strategies in these settings is critical. METHODS: Costs were obtained from experts in Nigeria, South Africa, Kenya, Rwanda, Uganda, and Malawi using known costs and published data, with estimation when necessary. A disability adjusted life years (DALY) model was applied using 3% discounting and 10-year length of analysis. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the WHO standard of cost-effectiveness ratio/gross domestic product per capita (CER/GDP) less than 3. RESULTS: Cochlear implantation was cost effective in South Africa and Nigeria, with CER/GDP of 1.03 and 2.05, respectively. Deaf education was cost effective in all countries investigated, with CER/GDP ranging from 0.55 to 1.56. The most influential factor in the sensitivity analysis was device cost, with the cost-effective threshold reached in all countries using discounted device costs that varied directly with GDP. CONCLUSION: Cochlear implantation and deaf education are equally cost effective in lower-middle and upper-middle income economies of Nigeria and South Africa. Device cost may have greater impact in the emerging economies of Kenya, Uganda, Rwanda, and Malawi.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Otol Neurotol

DOI

EISSN

1537-4505

Publication Date

September 2015

Volume

36

Issue

8

Start / End Page

1357 / 1365

Location

United States

Related Subject Headings

  • Quality-Adjusted Life Years
  • Otorhinolaryngology
  • Infant
  • Humans
  • Hearing Loss, Sensorineural
  • Equipment Failure
  • Education
  • Deafness
  • Cost-Benefit Analysis
  • Cochlear Implants
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Emmett, S. D., Tucci, D. L., Smith, M., Macharia, I. M., Ndegwa, S. N., Nakku, D., … Saunders, J. E. (2015). GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa. Otol Neurotol, 36(8), 1357–1365. https://doi.org/10.1097/MAO.0000000000000823
Emmett, Susan D., Debara L. Tucci, Magteld Smith, Isaac M. Macharia, Serah N. Ndegwa, Doreen Nakku, Kaitesi B. Mukara, et al. “GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.Otol Neurotol 36, no. 8 (September 2015): 1357–65. https://doi.org/10.1097/MAO.0000000000000823.
Emmett SD, Tucci DL, Smith M, Macharia IM, Ndegwa SN, Nakku D, et al. GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa. Otol Neurotol. 2015 Sep;36(8):1357–65.
Emmett, Susan D., et al. “GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.Otol Neurotol, vol. 36, no. 8, Sept. 2015, pp. 1357–65. Pubmed, doi:10.1097/MAO.0000000000000823.
Emmett SD, Tucci DL, Smith M, Macharia IM, Ndegwa SN, Nakku D, Mukara KB, Ibekwe TS, Mulwafu W, Gong W, Francis HW, Saunders JE. GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa. Otol Neurotol. 2015 Sep;36(8):1357–1365.

Published In

Otol Neurotol

DOI

EISSN

1537-4505

Publication Date

September 2015

Volume

36

Issue

8

Start / End Page

1357 / 1365

Location

United States

Related Subject Headings

  • Quality-Adjusted Life Years
  • Otorhinolaryngology
  • Infant
  • Humans
  • Hearing Loss, Sensorineural
  • Equipment Failure
  • Education
  • Deafness
  • Cost-Benefit Analysis
  • Cochlear Implants