Das Cochleaimplantat in der sozialgerichtlichen Rechtsprechung

Impact of Hearing Rehabilitation Using Cochlear Implants on Cognitive Function in Older Patients

OBJECTIVE

To assess the effects of hearing rehabilitation with cochlear implants on a subset of cognitive domains in older patients (≥65 yr).

STUDY DESIGN

Prospective observational study.

SETTING

Department of Oto-Rhino-Laryngology, Goethe-University Frankfurt/Main.

PATIENTS

Patients aged between 65 and 86 years who have received unilateral cochlear implant (CI) therapy.

INTERVENTION

Unilateral cochlear implantation.

MAIN OUTCOME MEASURES

The dementia screening test (DemTect) and the trail making test (TMT) were carried out on three occasions: previous to the surgery, at the initial fitting (about 1 month after surgery) and 6 months after surgery.

RESULTS

The average overall score on the DemTect scale increased significantly within 6 months of CI treatment (p = 0.049), with verbal aspects improving particularly markedly. The results of the trail making test showed that within 6 months of CI treatment, processing speed increased significantly (TMT A: p = 0.003; TMT B: p = 0.001).

CONCLUSION

A pre-post comparison showed that aural rehabilitation with a CI results in an improvement in cognitive subdomains. Further comprehensive randomized-controlled studies may be necessary to evaluate possible confounding variables and to assess long-term results.

Lifetime cost of unilateral cochlear implants in adults: a Monte Carlo simulation

BACKROUND/OBJECTIVE

Due to increasing prevalence of hearing loss and relaxation of candidacy criteria of cochlear implant (CI) supply, the number of implantations is likely to further increase. Statutory health insurances are facing ever more urgent financing challenges since CI treatment causes high life-long costs. Additionally, increasing life expectancy and earlier implantation may extend therapy time and cost. With every case being individual, this study aims to calculate the possible lifetime cost of unilateral CI treatment in adults including stochastic uncertainties.

METHODS

Taking a statutory health insurance perspective, relevant cost components of CI therapy and their values were identified. The Monte Carlo method was used to simulate lifetime cost considering age at first implantation and distributions of costrelevant variables. A sensitivity analysis was conducted to determine the most crucial variables impacting on lifetime cost.

RESULTS

Lifetime cost of CI treatment varies according to age at first implantation, respectively remaining lifetime; the earlier the implantation, the higher the overall cost. According to our simulation, the average lifetime cost for an adult patient first implanted between the age of 20-80 is at 53,030 € (present value). Cost of implantation and periodic speech processor exchanges show the highest impact on the total cost.

DISCUSSION

Health care systems could face rising expenses for CI supply by technical development. Innovative life-long CIs could achieve significant savings per case that could finance additional implant cost. Until then, further targeted research will be required.

CONCLUSION

CI-related cost for statutory health insurance crucially depends on the patient-side demand for cochlear implants. Therefore, cost forecasts must also consider the development of demand.

[Postoperative legal disputes involving patients with cochlear implants]

BACKGROUND

After the implantation of one or two cochlear implants additional problems often arise concerning the question which further costs have to be covered by statutory insurances or other insurance providers, e.g. within the framework of integration aid.

OBJECTIVE

This article provides an overview of judgments rendered by the German social courts. It was investigated whether and in which cases it is advisable for a patient to go to court, and how long the proceedings may take.

MATERIAL AND METHODS

A search was made for judgments in the two biggest commercial legal databases and in the database of the German social courts, using combinations of the search parameters "Cochlear", "Cochlea", "Implant", and "Implantat". The reviewed judgments were issued between 2002 and 2017.

RESULTS

A total of 13 judgments were found. The results varied according to the specifics of the individual case and 54% of the patients won their cases. The court procedures took between 2 months (starting from the filing of a complaint, date of application in this case unknown), and 6 years and 11 months.

CONCLUSION

This study showed that it is uncertain whether costs that are not caused directly by the surgery or the postoperative treatment will be remunerated. As each case is in principle unique, the results vary. Nevertheless, taking legal action is recommended after thorough consideration in cases where statutory insurances or other providers refuse to meet expenses incurred.