Copyright @ 200 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. 8 The Cost and Analysis of Nonuse of Cochlear Implants *Christopher H. Raine, †Quentin Summerfield, *David R. Strachan, *Jane M. Martin, and *Catherine Totten *Yorkshire Cochlear Implant Service, Bradford Royal Infirmary, Bradford; and ÞDepartment of Psychology, University of York, York, U.K. Objective: Analysis of the cost implications and reasons for nonuse of cochlear implants in an established cochlear implant unit. Study Design: Clinical data were analyzed retrospectively to construct a table of cochlear implant use over time to identify nonuse and to suggest the reasons for this. Setting: Yorkshire Cochlear Implant Service is a tertiary refer- ral center. Patients: Three hundred forty consecutively implanted patients from 1990 to 2005. Main Outcome Measures: Life table analysis showed that most children used their implant ( p = 0.7 during 11 yr). How- ever, 11 of 155 children and 2 of 185 adults became nonusers during the period of study. The 11 children stopped because of age at implant, educational placement, and family support. Two adults stopped because of psychological issues and inability to adapt to the signal. Surgical and implant costs have initial impact, with subsequent years_ costs reflecting programming issues and maintenance. When considering non- use, there are 2 effects: first, no more costs are incurred, and second, no more years of use are accumulated. Thus, nonuse reduces both costs and years. Costs of gaining a year of use as a function of time showed that there was little financial impact from the 11 children nonusers. As a ratio of Bno non- use[ and observed Bnonuse[ in children, the ratio is 1.07 by 13 years of implantation (7%). The adult group was too few to analyze. Conclusion: The nonuse added 7% to the average cost. Ret- rospective audit identifies that patient selection by a multi- disciplinary team is crucial to reducing nonuse. Key Words: Cochlear implantsVNonuseVHealth economics. Otol Neurotol 29:221Y224, 2008. During recent years, cochlear implants (CIs) have proven to be very effective in the management of severe/profound sensorineural hearing loss. The subse- quent nonuse of a CI is a disappointing outcome. Not only is no benefit received, but also, no benefit is received to offset the high cost of provision. In a large group of 5,363 of prelingually and postlin- gually deaf patients, West and Stucky (1) reported a 3 to 4% nonuse in postlingually deafened adults. A total of 174 (3%) patients were reported as being nonusers. During the 1990 to 1994 UK study, Summerfield and Marshall (2) produced a detailed analysis of cochlear implantation. Their economic model used a rate of 3.5% nonuse when assessing economic implications. In a cohort of 313 patients studied, 2 causes of nonuse in adults were identified: 1 was due to Bmortality,[ and the other was for reasons classified as Belective nonuse.[ At the time of analysis, 4% had died, and 6% had become nonusers. Address correspondence and reprint requests to Christopher H. Raine, Ch.M., Yorkshire Cochlear Implant Service, Bradford Royal Infirmary, Bradford BD9 6RJ, U.K.; E-mail: CHRaine@aol.com FIG. 1. Cumulative probability of children being users of an implant at different times after implantation. Error bars are 95% confidence intervals. Otology & Neurotology 29:221Y224 Ó 2008, Otology & Neurotology, Inc. 221