Influence of a health technology assessment on the use of pediatric cochlear implantation in Kazakhstan

2018 Fellowship of Postgraduate Medicine Objective: To evaluate the influence of a health technology assessment (HTA) on pediatric cochlear implantation (CI) in Kazakhstan and to provide a further perspective on the use of the technology in that country. Ideally, children should be implanted as young as possible, have adequate rehabilitation, and be integrated into the regular school system. Methods: Administrative data for 2013-2016 relevant to pediatric CI in Kazakhstan were obtained from the Ministry of Health and from a survey of authorities in the 16 regions of the country. The data were compared with those for 2007-2012 used in preparation of the HTA report. Results: Funding continued to be available only for unilateral CI, a clinical protocol for the procedure was finalized and availability of equipment for audiological screening had improved considerably. In Kazakhstan the proportion of children over 5 years old at implantation had decreased by 65%, while that for children less than 2 years old had increased from 12 to 35%. Rehabilitation of children post-implantation was limited by the small numbers of suitable specialists. There was an increase in numbers of children enrolled in schools for those with moderate or profound hearing impairment. The number of children educated in standard schools remains low. Conclusion: The HTA made a useful contribution to the development of cochlear implantation services in Kazakhstan. The shortage of specialists for provision of rehabilitation and the limited placement of implanted children in general schools are matters for government decision - makers to consider.