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10/09/2015  |   1:45 PM - 3:00 PM   |  Andrew Foster Auditorium

Cochlear Implantation and Deaf Education in Sub-Saharan Africa: A Cost Effectiveness Study

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 5-6 times higher in low and middle-income countries compared to the US 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) <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 0.55-1.56. The most influential factor in the sensitivity analysis was device cost, with the cost effective threshold reached in all countries employing discounted device costs that varied directly with GDP. Conclusions: 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.

• Examine current capacity for cochlear implantation (CI) in Sub-Saharan Africa
• Evaluate cost effectiveness of CI and deaf education in this region

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Susan Emmett, MD, MPH (POC,Primary Presenter), Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, semmett2@jhmi.edu;
Susan Emmett is currently serving as chief resident in Otolaryngology-Head and Neck Surgery at Johns Hopkins in Baltimore, MD. Originally from Memphis, TN, she obtained a Bachelor of Arts from Princeton University in Molecular Biology and the Woodrow Wilson School of Public and International Affairs. She worked as a health legislative aide for then Senate Majority Leader William H. Frist, MD prior to matriculating at Duke University School of Medicine. A highlight of medical school for Susan was spending a year in Moshi, Tanzania, where she worked as a Howard Hughes Medical Institute Research Training Fellow. She has lived in Baltimore since starting residency in 2010. A major emphasis of her training has been in public health, including a Master of Public Health from the Johns Hopkins Bloomberg School of Public Health and postdoctoral research fellowship focused on nutrition and hearing loss in South Asia. Susan plans to pursue a career combining Otolaryngology and global health after graduation from residency.