Post-implantation clinical cost analysis between transcutaneous and percutaneous bone conduction devices

Introduction: Bone conduction devices (BCD) are effective for hearing rehabilitation in patients with conductive and mixed hearing loss or single-sided deafness. Transcutaneous bone conduction devices (tBCD) seem to lead to fewer soft tissue complications than percutaneous BCDs (pBCD) but have other drawbacks such as MRI incompatibility and higher costs. Previous cost analyses have shown a cost advantage of tBCDs. The purpose of this study is to compare long-term post-implantations costs between percutaneous and transcutaneous BCDs. 

Materials and methods: Retrospective data from 77 patients implanted in a tertiary referral centre with a pBCD (n = 34), tBCD (n = 43; passive (t_pasBCD; n = 34) and active (t_actBCD; n = 9) and a reference group who underwent cochlear implantation (CI; n = 34), were included in a clinical cost analysis. Post-implantation costs were determined as the sum of consultation (medical and audiological) and additional (all post-operative care) costs. Median (cumulative) costs per device incurred for the different cohorts were compared at 1, 3 and 5 years after implantation. 

Results: After 5 years, the total post-implantation costs of the pBCD vs t_pasBCD were not significantly different (€1550.7 [IQR 1174.6–2797.4] vs €2266.9 [IQR 1314.1–3535.3], p = 0.185), nor was there a significant difference between pBCD vs t_actBCD (€1550.7 [1174.6–2797.4] vs €1428.8 [1277.3–1760.4], p = 0.550). Additional post-implantation costs were significantly highest in the t_pasBCD cohort at all moments of follow-up. 

Conclusion: Total costs related to post-operative rehabilitation and treatments are comparable between percutaneous and transcutaneous BCDs up to 5 years after implantation. Complications related to passive transcutaneous bone conduction devices appeared significantly more expensive after implantation due to more frequent explantations.