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Scientific Oral Presentations

Business of Medicine

Session: Scientific Oral Presentation 1 - Business of Medicine

Time-driven Activity-based Costing (TDABC) of Cochlear Implantation: A Multi-institutional Study

Monday, October 13, 2025
3:00 PM - 3:06 PM EDT
Location: 109-110
Introduction: Cochlear implants (CIs) are an effective treatment for sensorineural hearing loss, but its cost to the healthcare system remains high. Time-driven activity-based costing (TDABC) is a methodology that can be used to accurately measure the costs of a clinical program and identify opportunities for cost reduction and quality improvement. The objective of this multi-center study was to perform TDABC analysis of personnel costs for preoperative and postoperative audiology and otology care for cochlear implantation.

Methods: TDABC of CI programs at 2 tertiary centers (University of California San Francisco (UCSF)) and Massachusetts Eye and Ear (MEE)) was conducted in 2023-2024. The process for first-time CI recipients was analyzed and mapped through in-person observation. Personnel costs were calculated using public government data. Consumable supply and overhead costs were excluded. CI surgery itself and its intraoperative costs were not examined.

Results: Analyzed appointments included preoperative audiologic evaluations (1 at MEEI, 2 at UCSF), 1 preoperative neurotology evaluation, 1 postoperative neurotology visit, and 2 CI activations. Mean total personnel cost for preoperative and postoperative care for CI recipients was $266.26 ($290.34 at UCSF, $228.85 at MEEI). 68% ($181.30) was due to audiology costs. The 2 institutions differed in their clinical workflows, including the number of preoperative audiology visits, timing of postoperative visits, and involvement of advanced practice practitioners (APPs), but had no statistically significant difference in costs (p>0.05 for CI preop neurotology evaluation, postoperative neurotology visit, and CI activations).

Conclusions: Personnel costs, a major driver in cochlear implantation, were $266.26. Despite differences in clinical workflow, costs were similar between 2 institutions.

    Presenting Author(s)

  • EK

    Eric K. Kim, MD

    Resident Physician
    University of California - San Francisco
    San Francisco, California, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • KP

    Kami Pullakhandam, BA

    Harvard Medical School, United States

    Disclosure information not submitted.

  • BB

    Brooke Barry, BA, BS

    University of California - San Francisco, United States

    Disclosure information not submitted.

    • Presenting Author(s)

  • MZ

    Michelle Zhang, BS

    Harvard Medical School, United States

    Disclosure information not submitted.

    • Co-Author(s)

  • Alice Q. Liu, MD

    Resident Physician
    University of British Columbia
    Vancouver, BC, Canada

    Disclosure information not submitted.

  • Rebecca M. Lewis, AuD, PhD

    Chief of Audiology
    University of California, San Francisco
    San Francisco, CA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Nicole T. Jiam, MD

    Otology, Neurotology & Skull Base Surgery
    University of California - San Francisco
    San Francisco, CA, United States

    Disclosure information not submitted.