Since August 2006, NICE, the National Institute for Health & Clinical Excellence has conducted a Health Technological Appraisal on the subject of “Cochlear Implants for severe to profound deafness in children and adults”. NICE’s remit is to develop authoritive guidance for the NHS in England & Wales on the clinical and cost effectiveness of healthcare interventions and on the treatment of clinical conditions. By issuing such guidance, NICE promotes equitable access to treatments of proven clinical and cost effectiveness and faster uptake of new technologies.
On 28 Jan 2009, NICE published its Final Appraisal Guidance (FAG) in which its reccomendations are:
1. Unilateral cochlear implantation is recommended as an option for children and adults with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids.
2. Simultaneous bilateral cochlear implantation is recommended as an option for the following groups of people with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids;
.1 Children
.2 Adults who are blind or who have other disabilities that increase their reliance on auditory stimuli as a primary sensory mechanism for spatial awareness
3. Sequential bilateral cochlear implantation is not recommended as an option for people with severe to profound deafness.
4. People who had a unilateral implant before publication of this guidance, and who fall into one of the categories described above, should have the option of an additional contra lateral implant only if this is considered to provide sufficient benefit by the responsible clinician after an informed discussion with the individual person and their carers.
5. Further research should be conducted into the cost effectiveness of bilateral implants vs. unilateral implants in adults for another NICE review in Feb 2011.
The full publication of this Final Appraisal Guidance can be seen here.
The background to this successful outcome , in which the NCIUA played a contributary role, is as follows.The formal NICE consultation process took place between Jan and April 2007 .The NCIUA , as a Parent/User Group consultee, prepared a submission that there is a strong case that cochlear implantation is a proven and cost effective treatment for the restoration of speech perception and communication in deaf people and the provision of hearing to those born deaf. The full NCIUA submission can be seen here.
On November 2007 the NCIUA attended an Expert Witness Meeting for which Nigel Williams (Chairman) and Tricia Kemp (Vice Chairman) submitted their personal experiences as required by the NICE process. These can be seen here for Nigel Williams and here for Tricia Kemp.
There is a NICE webpage on this Appraisal Programme which can be seen here. That site provides access to the Evaluation Report and importantly, to the Appraisal Consultative Document (ACD1), published in Dec 2007, which, as part of the consultative process, invited everyone to read and comment on the provisional conclusions and recommendations. A second ACD was issued in Mar 2008 and this gave rise to many objections to the deletion of some of the ACD1 recommendations. These documents, ACD1 can be seen here and ACD2 here.
The draft Final Appraisal Determination (FAD), which can be seen here, was released on 2 Sept 2008.This draft FAD was subject to appeal and on 15 October 2008 it was announced that an appeal had been lodged. The Appeal was held in public on 26 November 2008 and was unsuccessful.
The NHS is required to provide funding and resources for treatments that have been recommended by NICE technology appraisals normally within 3 months from the date that NICE publishes that Guidance.