A narrative review of the logistic and economic feasibility of cochlear implants in lower-income countries

Abstract

Objectives: Globally, less than 1% of people who could benefit from a cochlear implant have one and the problem is particularly acute in lower-income countries. Here we give a narrative review of the economic and logistic feasibility of cochlear implant programmes in lower-income countries and discuss future developments that would enable better healthcare. We review the incidence and aetiology of hearing loss in low- and middle-income countries, screening for hearing loss, implantation criteria, issues concerning imaging and surgery, and the professional expertise required. We also review the cost of cochlear implantation and ongoing costs.

Findings: The cost effectiveness of cochlear implants in lower-income countries is more limited by the cost of the device than the cost of surgery, but there are also large ongoing costs that will deter many potential users.

Conclusions: We conclude that the main barriers to the future uptake of cochlear implants are likely to be logistical rather than technical and cochlear implant provision should be considered as part of a wider programme to improve the health of those with hearing loss.

KEYWORDS:

• Hearing loss
• Cochlear implants
• Developing countries
• Surgical approaches
• Low cost devices
• Cost effective

Notes on contributors

Ellie Bodington is a junior doctor based in East Yorkshire. She obtained a BSc. in Biomedical Science from the University of Hull prior to completing her medical degree at the University of Warwick. She is currently a specialist trainee in obstetrics and gynaecology.

Shakeel R. Saeed is Professor of Otology / Neuro-otology at University College London, Ear Institute and Consultant ENT and Skullbase Surgeon, UCLH Hospitals. His Doctorate thesis was awarded a Gold Medal by Manchester University in 2003. He is President of the European Academy of Otology and Neurotology and past President of the Royal Society of Medicine, Section of Otology, the British Skullbase Society and the British Society of Academic Otorhinolaryngology; he is a former Vice-President of the British Cochlear Implant Group. He was involved in setting up the first cochlear implant centre in Pakistan in 2000.

Michael C. F. Smith is a consultant ENT surgeon and Otologist trained in the UK and a founder and Head of Ear Services at the International Nepal Fellowship Green Pastures Hospital Ear Centre in Pokhara Nepal. The dedicated Ear Centre opened in 2015 and is active in training ear surgeons and primary health ear care workers. He has led numerous teams conducting surgical ear camps in remote regions of Nepal. His association with medical services in Nepal extends over 40 years, of which he has spent more than 15 years working full time in the country. He has also visited and worked in various other LMICs. He is chairperson of the charity Ear Aid Nepal and a member of the Coalition for Global Hearing Health Advocacy Committee.

Nigel G. Stocks is the Director of the Warwick Centre for Predictive Modelling and formerly Head of the School of Engineering at the University of Warwick. His research interests include stochastic non-linear dynamics and random and event based sampling with application to hearing.

Robert P. Morse is an engineer working in Egypt. After several years in industry working as an electronic engineer he returned to academia to get his PhD at Keele University (UK). His next 25 years were focussed on the development of stochastic cochlear implant coding strategies. In 2014 his focus switched to developing technology and infrastructure to expand the use of cochlear implants and hearing aids in lower-income countries.

Notes

1 In much of the literature costs are expressed in US dollars. Throughout this report values are therefore given in US dollars based on values from the literature or converted using XE.com/currency tables for January 1st for the publication year of the cited article.