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Cochlear Implants not value for money?

Wales is to get £750,000 for its cochlear implant programme, to implant 20 adults in 2007-08. That is £37,500 per person, this represents a 60% increase in the CI programme. From these figures, Wales implants 33.33 people each year. Wonder how they give 1/3 of an implant to some random person? This means that the Welsh Assembly is currently spending £1,250,000 per year on cochlear implants for adults. Children already have their own money.

The funding for interpreters in Wales is a shambles, with £1 million £2.7 million as a one off cost, and not spread throughout Wales. Where is the recurring funding for BSL? And this funding for BSL is for BOTH adults and children. Unequal money, certainly. The lack of funding in this area, especially in rural areas (currently none of the £1 million is reaching Powys, why?) means that people are being pushed unnecessarily towards an medical route, because viable alternatives are not being made available.

These people who are going to get CIs, are deaf and will probably still use communication support. Cost per head is expensive.

The Welsh Assembly seriously needs to get its act together.

Update: for international readers, this is public money. i.e. the taxpayer is paying 100% for this, not some insurance company. See previously here and here, should public money be inflating a businesses' profits, shareholders dividends, and director's salaries to a huge degree? Cochlear is on a 20% growth strategy, because they can see there is money to be made. The taxpayer is paying for these perks. With such an aggressive marketing strategy in mind, are alternatives even taken seriously or just token to create the illusion of suiting some health policy? The inequality around funding especially for alternatives, and how this filters through into the voluntary sector, is kind of a no brainer. Public funding feeding this approach, is questionable and perhaps irresponsible.

Source

Minister announces £750,000 cochlear implant programme
Ian Morgan

More adults with profound hearing difficulties are set to benefit thanks to a new £750,000 cochlear implant programme, Health and Social Services Minister, Dr Brian Gibbons, announced today (Wednesday).

The new funding will mean that all of the patients currently waiting for an implant will be able to be treated.

It is anticipated that the programme is expected to help over 20 patients in the next financial year 2007/08.

Currently the implants are only available in a very few exceptional cases.

This represents an increase of over 60% in funding for the cochlear implant programme.

Dr Gibbons said: “Cochlear implants can make the world of difference to people who are profoundly deaf or severely hard of hearing. The funding I have announced today means that we can dramatically increase the number of people we can treat across Wales.”

A cochlear implant is a surgically implanted electronic device that can help provide a sense of sound to a person who is profoundly deaf or severely hard of hearing.

Patients are assessed individually as to whether or not an implant is appropriate. The assessment takes into account a person's hearing history, cause of hearing loss, amount of residual hearing, speech recognition ability, and general health.

Unlike other kinds of hearing aids, the cochlear implant does not amplify sound, but works by directly stimulating any functioning auditory nerves inside the ear with electrical impulses. External components of the cochlear implant include a microphone, speech processor and transmitter.

Under the appropriate conditions, an implant can give a deaf person a useful auditory understanding of the environment and hearing and help them to understand speech, although post-implantation therapy is usually required.

The new programme will be delivered by Health Commission Wales who already commission cochlear implants for children.

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» CI funding in Wales again, a political football from Grumpy Old Deafies
A couple of days ago, Glyn Davies AM reported on the fact that someone could not get a CI in Wales, because of a lack of funding. Today he goes onto expand this, by citing the consultant's letter and slamming... [Read More]

Comments (18)

The cost of a CI is (usually) covered by insurance.

However (!) the cost of driving back and forth for mapping, adjusting, and so on is on the individual and this is the only thing that holds me back. I would have to drive several hours EACH WAY to be adjusted and for how long?

I have an excellent auditory memory and I would be a prime candidate, but I do not want to be killed or disabled while driving in heavy traffic.

I do think that this subject should be brough up in a website by someone who KNOWS.

Thankyou, Lantana

Gosh, that's ridiculous! Paying a million and a quarter quid for 33.33 people when that same money would fund interpreters for so many more people!!! Thanks for bringing this to our attention.

It is a waste of money! It is not going to cure anyone. It does not mean that they will be hearing like them. They will remain DEAF! They are dummies for spending the moolah! tsk! tsk!

Shame on them for wasting our money!

Tell them to change and use money wisely to help deaf get equal communication access as well as provide services for deaf community.

If they want to play like HItler, they are in wrong business.

Good Luck!

=)

I should stress re the above, this is Wales, which means we have a National Health Service. That money is coming from the taxpayer's pocket, and is publically funded.

£1,250,000 of taxpayers money per annum, for 33.33 adults.

Another thing that occurred to me, from this post and this one, this PUBLIC MONEY for 33.33 adults, is just going into shareholder's pockets.

The value of the company is at A$3.46 billion, it is after 20% growth, CEO earns around AUS$700,000 per annum, and its a highly profitable company since shares are rocketing.

Should public money be going to such a highly profitable company?

The value in the CI is not in hard cash. If it was we could well question the finanacial 'value' of £30m plus spent on deaf people last year, what have deaf and HI actually got out of it ? Money spent on culture is wasted, money spent on support is what gthere.

While I can't comment directly on this issue from the perspective of Welsh Public funds - I live in Canada - we also have a public funded medical system and I see similar comments here. There are always other things to consider in these questions - the cost of implanting one person is high I agree, but consider this most successful CI users (the success of any patient is always the variable but my research indicates MOST CI patients enjoy very good success) will require less public money in the long run, less than they would have if they had not received the device. I use myself as an example - I am a late deafened adult, (my wife is not sure about the Adult part most of the time but that is different story) the sudden loss of my hearing was devistating for me, not just emmotionally (amother long story) but also professionally. I work in a sales support role for a large company and I have to hear to work. Now my employer was wonderful making accomodation to "work around" my disability (and for me this became a huge disability) but the bottom line is I was not able to properly perform the job I was employed to do! I was faced with changing jobs (not what I wanted to do) if I could find something I could do without hearing the options are limited in most places I know of or ending up out of work on some type of assistance. The cost to in public funds would have been much higher to support me and my family had that been necessary. My Implant, surgery, and the onging follow-up probably cost over $100,00.00 Cdn (my best guess I have no hard figures) and that is big money in anyone books, but the cost to the public would have been much higher if I had not received the Implant. I have been able to continue to work, I still pay taxes and I am happy to see some of my tax dollars go to cover programs such as Cochlear Implants. I know not every patient's story is like mine, but I also know I am not unique, many CI Patients are like me especially the late deafened. Yes CI programs are expensive, but I consider the money our Medicare system spent for my CI an investment - and a darn good one.
I also think we need to keep in mind "Profit" is not a dirty word, companies like Cochlear, Boston Scientific, and Med El are in business to make money, there is nothing wrong with that, they invested huge sums of money to developed some amazing devices for treatment of hearing loss and to continue to invest to improve these and develop new and better devices and treatments. These companies need profit that is how it works, some (often much) of that profit is reinvested in further development. We need to remember it costs huge amounts of money to develop these devices, and another huge amount to get them approved for use. Unless of course we want to leave it to governemnt to to fund that development - and I don't want to think about that possibility... Yes government may make stupid choices on how to spend public money - I am sure we can all think of many bad spending choices by our own politicians, but I think if we consider all aspects of a CI program and the total cost to the public this is "Good Value for Money spent."

For the pro-culture,and anti-CI sector, no CI will ever be a viable or ethical option, they are rampant audiophobes. They will justify many millions spent on maintaining and supporting deafness, while opposing anything that can break that vicious circle, and they don't care that other deaf want CI's either. They'll never understand, there's no point in explaining to them. Ignoring their view is the best option, and supporting those who want CI's, it's a free world or supposed to be.

Dear MM, you're not very good at following your own advice are you?

I'd just like to point out that not all the money quoted by the assembly will go to implant manufacturers. The funding also pays for our nurses, surgeons, audiologists and other hospital staff.
There has been a huge amount of research done on the cost effectiveness of cochlear implants and it has always been found that the costs are matched by the benefits - if they didn't then health authorities and insurance companies wouldn't pay for them - they're not stupid!

Dear MM, you're not very good at following your own advice are you?

Posted by: JGJones | April 1, 2007 11:19 PM

I can be pretty good at ignoring you 'though ! This is just another thinly-veiled tirade at CI's by Grumpy (Again !), the CI argument is LOST on the cultural side, I really cannot see the point of all these digs at CI's. They had 2.7m for BSL yet begrudges CI options for others, doesn't take rocket science to work out the size of her chip does it ?

The difference is the CI money is *recurring*, i.e. every year. The BSL money is one off.

If deafened people want this money, fine. However, I question:

a) public funding to finance huge company profits,
b) the lack of recurring nature of BSL funding.

In fact its not BSL funding, the Welsh Assembly has not even touched this. The 2.7 million is for interpreters, thus does not even begin to address issues in rural parts of Wales.

If your argument is purely a finance based one then do you agree that Herceptin (cancer drug that costs £40,000 for 2 year treatment) should not be available on the NHS because that money will go to the company Genetech?
It is easy to pick a fight with a product that you personally don't want. My cousin has an implant and it has allowed him to do many things that he couldn't do with hearing aids. He doesn't want Herceptin - why should he pay for that? Welcome to the real world - you have to pay for things you personally don't want in order to have an NHS. If you want to opt out of the NHS then move to America where you have to pay an insurance company rather than the government.

Once you start 'comparisons' on cost of support and operations then you are in a minefield, Do we justify sign language support ? they could all stay in the deaf world where communication isn't an issue etc. Most DO anyway !

Terps cost access costs, CI's cost what has it to do with those who don't want one anyway ? Prices of CI's are due to plummet anyway as India claims to have found a way of making them dirt cheap.

THEN Grumpy will really have her work cut out as the rush starts.

Herceptin keeps people alive, and to compare CIs and Herceptin quite frankly is an insult to cancer survivors.

However, yes I would ask the question again with drug companies, are they making excess profits off public services. Remember when the price of digital hearing aids came down, because of bargaining / purchase power of the buyer. Why can't the same thing happen for other products that are purchased? That said, do we really need a more aggressive approach to CIs?

The issue with CIs, is they do *not* make a person hearing. If a deafened person wants a CI, go ahead. However, what really scares me (apart from a one track mind and a lack of holistic approach that comes from ENT surgeons) is the lack of choice and availability for other services, e.g. rehabilitation, training, and communication. That is what makes a person function. Noone (deafened people included) should just be reduced to a piece of technology.

Comparing costs of services and outcomes is exactly what is done in Health Economics. Sorry to have to bring Herceptin in to get you stirred up but it is the job of NICE and the NHS to make sure that all services offered by the health service are cost effective, safe and good value for money. Herceptin and cancer drugs have to go through this process as well as CIs and it isn't insulting to compare the two on this basis. I didn't compare them anyway! I was asking the question whether, if you base your argument entirely on cost, you disagree with expensive drugs too.
CIs are offered on the NHS because they have been shown to be a cost effective form of treatment. Heart bypass operations, cancer drugs, implants are high cost, high outcome improvements and so the NHS pays for them (as do insurance companies in other countries). If a treatment is expensive but doesn't have high outcomes then it is not paid for. So I think your argument about cost is a moot point.
However I completely agree with your argument that people should be treated as a whole person and not just a pair of ears or a piece of technology.
I think you can fight for more funding and access for Deaf and deafened people without suggesting that we take funding away from those who choose to have cochlear implants.

Other thing, people be reduced to cost effectiveness, re alternatives for choice. Unfortunately one commenter here said on my AM's blog that all deaf people should have CIs, as it was more cost effective. Why not bring in the Nazi's to rule while they are at it?

In terms of society cost effectiveness. Why not inject all black people and make them white. Would be much more cost effective than having to deal with their access, Commission for Racial Equality, setting up anti race discrimination legislation in organisations up and down the country! See how irrational the argument is? Bottom line is, you have to respect diversity, and it makes the world spin. Likewise, medicine is not a be all and end all fix. We could also get into eugenics here.

I am *not* arguing away CIs for deafened people. If they want them, go and have two, for all I care. However:
- imbalance of services. e.g. deafened people are still not hearing if they get a CI, where's the *social* access? They will still need communication access with a CI, e.g. speech to text;
- the public sector financing huge profits of the private sector.

Its like me holding an interpreting agency accountable. Some agencies, and interpreters out there charge way too much money. Is the public sector, who often pays for this, getting value for money? Often not. However, because demand outstrips supply by a huge degree, we don't have market economics to pull this down.

Individuals don't irk me. Most of my banging on this drum has to do with imbalance of information, and how a multi billion industry is driving an agenda without giving a decent chance for anything else. Like it or not, this *does* have an effect on other services, and perception. CI industry indirectly impacts me, as any other person out there.

Now you are being ridiculous. Because you and Grumpy hate CI's because of your cultural bias we are all exposed to these regualr 'digs' and attacks on them. we'd respect both your view more idf you simply stated the honest view as you hold, in that you don't like them and want to oppose their usage with deaf people,that. it has NOTHING whatever to do with you or Grumpy makes it even more annoying. CI's impact on you ? please elabourate ! what have YOU lost or GRUMPY has lost by other deaf or their children having them ? Now we are getting to it, you want the cash to bolster YOUR cause celeb ! DEaf sign users get miliions every year,year in, year out, local authorities buy them clubs to mmeet in,not enough you say they shouldn't be attemtping to give sound access to deaf people or we'll lose members. If youare hoping allthese thinly-veiled digs and whinges at CI's will make an iota of difference, it won't. Statistics clearly show the MORE you are against them, the more people WANT them. IMplantation is ata world high presently, and now they are goping bi-lateral i.e. havingtwin implants,when will you accept you have lost this argument,and why, are you opposing other deaf people's choices and interfering with parental ones ? are YOU a parent of a deaf child ? have YOU been offered a CI and refused ?

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