Implementing changes to the eligibility criteria for cochlear implants (budget impact analysis)

Key Findings

Cochlear implants are deemed to be clinically and cost effective based on pre-existing NICE technology appraisal guidance (TA566).
Changes to the assessment of eligibility for cochlear implants is expected to increase the number of people eligible to receive a cochlear implant in Scotland.

• Our main (base case) analysis suggests an increase in the number of patients treated from the current figure of 99 per year, to 173 patients receiving a cochlear implant year on year within five years – an increase of 74 per year.
• This increase in annual patient numbers was varied in four scenario analyses ranging from 47 additional patients (a 37% increase) to 113 (114% increase).
• These figures represent a 5% (3% to 8%) increase in the total number of patients known to the service (i.e. total patient cohort).

The base case budget impact analysis illustrates that an estimated £2.27m additional funding is required annually. Depending on the range of uptake described above, the additional annual amount required could be between £1.5m and £3.4m.

Costs were calculated across an anticipated five-year eligibility criteria implementation period, and annually thereafter. The per-patient cost analysis included the following: resource associated with additional patients referred to the service; implantation costs for those patients who are suitable and wish to proceed with surgery; hospital stay; annual post-implantation support; additional maintenance; spare parts and repairs; overheads; processor stock; and upgrade costs.

The results may differ from the NICE analysis owing to the need for the base case analysis to use both population estimates and unit costs relevant to Scotland. The impact of applying the NICE costs was explored within scenario analyses.

What were we asked to look at?

We were asked to estimate the potential budget impact of changing the eligibility criteria for cochlear implants in Scotland. This follows a change to NICE guidance in England, which includes modifications to the clinical criteria for what constitutes severe or profoundly deaf, and how ‘adequate benefit’ from hearing aids is measured.

Why is this important?

The Scottish Cochlear Implant Programme is a centrally provided national service, hosted within NHS Ayrshire & Arran and funded through the National Services Division (NSD) of NHS National Services Scotland. Changes to the eligibility criteria will increase the number of people eligible for cochlear implants, which may have resource implications for the national service, depending on uptake. There is currently low uptake among the total eligible population in Scotland, and any change to criteria may also raise awareness of eligibility, leading to increased demand and a reduction in unmet need.

The revised criteria are already being implemented in England following an update to the NICE guidance in March 2019. There is a need for NSD to consider patient access in Scotland.

Referred by

The National Services Division (NSD) of NHS National Services Scotland