RESULTS INQUIRY 2009 by Dr Ruud van Hardeveld

Editor's Note: This is the presentation which Dr Ruud van Hardeveld gave at Varese in April 2010.  We apologise that not all the slides can be read easily, now that they have been reduced in size to e-mail with Ruud's commentary.  If you would like a copy of Ruud's PowerPoint slides as a pdf, please e-mail brian.archbold2@btinternet.com

I am pleased to present the results of our yearly inquiry on cochlear implantation in 2009.

Firstly I would like to thank all who made it possible to make this review as, for most of you, it proved to be difficult to obtain the data.

Many of you had to contact the individual implant centres because of the absence of a central registration in your country.

Central registration exists only in a few countries, like Switzerland, Belgium, and Netherlands.

The data which we obtain show to be more and more difficult to interpret.  We have to recognize that not the number of implantations but the number of persons which enjoy the benefits of a cochlear implant is the most important number for us.

Central registration offers a number of important advantages as can be concluded from the data in the next slide in which I show you the data as obtained from the Netherlands.

I only present the cumulative total numbers of the eight implant centers in the Netherlands.  However, the data is also available for the individual implant centres.

Looking at the individual numbers it becomes clear that there are great differences in the re-implantation percentages for the individual centres without a visible course.

For children the mean re-implantation percentage of 2.1 varies in between 0 – 5.7 % and for adults the mean percentage of 4.8 varies even more i.e. in between 1.5 and 6.5 %!!

These differences should lead to discussions with the various implant centres about the reasons of their deviating individual performance.  A thorough analysis of the reasons behind the re-implantations is necessary.  The behaviour of the CI-wearers, the implantation procedure (selection and/or surgery procedure) and the brand or type of implant can be of influence.

This analysis should show the way to a better performance and increased reliability of the implantation procedure.

Importance of this inquiry

• It gives us tools to convince decision-making authorities in Government, Social Insurances and all involved in management of Cochlear Implants what the status is of the implantation effort in their country.
• It gives convincing arguments to plead for raising the efforts on a national level.

The importance of the inquiry is not only the comparison of the data of the individual countries.  It gives us also tools and arguments to convince the decision making authorities to raise the efforts on a National Level.

Now, let us look first at the reliability of the data which I am going to present.

From a number of countries no data was obtained.  However, to make an estimate of the possible data of these countries in 2009, I took the 2008 data and added the number of implantations in 2008 for children and adults.  In fact I assumed that the number of implantations remained constant.

I used this procedure also in forgoing years and it turns out that the data thus obtained didn’t differ much from those delivered this year.

Further it turns out that the total number of CI-users per ultimo 2009 = 73,000.  The increase of 9,000 CI-users with respect to 2008!!

If we include POLAND, RUSSIA, BELARUS, the BALKAN the total Ci users in Europe is estimated to be 10,000.

From the 2009 Annual Report of COCHLEAR, I learned that the total sales of CI’s in 2009 was 18500 !! (http://www.cochlear.com/corporate/annual-reports).  Now, it is easy to calculate the volume of the European market by estimating the output of Cochlear on Europe at 40% of its capacity and the market share at 70%.  This gives an European market of about 10500 CI’s

The two estimates come amazingly close together.  This allows me to conclude that the data as obtained by our members are rather reliable.  And that the TOTAL number of CI-wearers in the EURO-CIU member states is 73,000 per ultimo 2009.

Now we come to the detailed data.

This diagram shows the absolute numbers of CI-wearers in the various countries and it is obvious that large countries show large numbers.

An honest comparison of this data is only possible with relative numbers, that is to say with numbers per million inhabitants, since these show clearly the differences in effort in the various countries.

This is shown in this slide which is self explanatory. The total numbers of implantations per million inhabitants varies from 270 in Germany to 50 in the Czech Republic.

The richer countries come to higher relative numbers for the total of CI-users.

Great differences in the spending of the financial means in the various countries become visible in the ratio of the number of adults versus children.

In countries like Estonia, Czech Republic, Turkey and Hungary most money goes to CI’s for children.

Also in Switzerland, Spain and Norway the effort for children is larger than for adults, but here we have to do with countries which made an early start with bilateral implantation for children.

In this slide the relative number of implantations in 2009 is shown.

Noteworthy is in the right hand side of this graph as it appears that implantation of CHILDREN in Estonia, Czech Republic, Turkey, Austria and Hungary makes up more than 50 % of the total numbers of implantations in these countries.

The mean number of implantations for children is about 8, with the remark that Germany unexpectedly strongly deviates and the value of 10 in Turkey should be corrected for the high birth rate by a factor of two (2).

So, it seems that with the number of about 8 to 9 implantations per million inhabitants the natural limit which is given by the number of children which are born deaf or profoundly deaf is reached.

This number can be expected with a birth rate of 10 per 1,000 inhabitants i.e. 10,000 children per million and the prevalence children born deaf or profoundly deaf of 12 per 10,000 births. So we have to conclude that in between 66 and 75% of these children is implanted.

This slide gives the number of births per 1000 inhabitants in the various countries.

I give these numbers just to show you that number of children implanted per million inhabitants in a country has to be dealt with carefully.

In fact we have to correct that numbers for the birth rate because it is reasonable to assume that the number of children born with a hearing impairment per 1,000 births will be equal all over Europe.

So twice as many children with a hearing impairment per million inhabitants will be found in Turkey than in Germany and Italy.

This slide confirms this conclusion if the data for children in 5 consecutive years are compared.  The number of implantations in the various countries is remarkably constant over the 5 years shown.

It goes too far to discuss at this moment the individual deviations but the trend in the various countries is rather stable.  Our members should make their own conclusion of the position of children implantation in their country relative to the indicated mean.

This slide gives data on the mermberships in the associations.

The absolute number of CI users in associations differs greatly in the various countries.  This diagram shows that we can learn a lot of the Spanish organisation which is able to have about 40% of the users in their organisation.  Less visible is that the degree of organisation in Sweden, Luxembourg and Estonia is also 40 to 50 %.

This slide shows the degree of organisation of CI users in the various countries. The highest degree of organisation is found in the smaller countries with active associations.

This slide shows the development of Cochlear Implantation in the various countries during a period of 5 years.

The differences in steepness of the increase of the total CI numbers during these years gives insight in the differences of the growth in effort.