Borre ED, Dubno JR, Myers ER, Emmett SD, Pavon JM, Francis HW, Ogbuoji O, Sanders Schmidler GD. Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA.
J Gen Intern Med 2023;
38:978-985. [PMID:
35931909 PMCID:
PMC10039166 DOI:
10.1007/s11606-022-07735-7]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND
While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested.
OBJECTIVE
We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA.
DESIGN
Model-based cost-effectiveness analysis simulating Current Detection (CD) and linkage of persons with HL to hearing healthcare, compared to alternative screening schedules varying by age at first screen (45 to 75 years) and screening frequency (every 1 or 5 years). Simulated persons experience yearly age- and sex-specific probabilities of acquiring HL, and subsequent hearing aid uptake (0.5-8%/year) and discontinuation (13-4%). Quality-adjusted life-years (QALYs) were estimated according to hearing level and treatment status. Costs from a health system perspective include screening ($30-120; 2020 USD), HL diagnosis ($300), and hearing aid devices ($3690 year 1, $910/subsequent year). Data sources were published estimates from NHANES and clinical trials of adult hearing screening.
PARTICIPANTS
Forty-year-old persons in US primary care across their lifetime.
INTERVENTION
Alternative screening schedules that increase baseline probabilities of hearing aid uptake (base-case 1.62-fold; range 1.05-2.25-fold).
MAIN MEASURES
Lifetime undiscounted and discounted (3%/year) costs and QALYs and incremental cost-effectiveness ratios (ICERs).
KEY RESULTS
CD resulted in 1.20 average person-years of hearing aid use compared to 1.27-1.68 with the screening schedules. Lifetime total per-person undiscounted costs were $3300 for CD and ranged from $3630 for 5-yearly screening beginning at age 75 to $6490 for yearly screening beginning at age 45. In cost-effectiveness analysis, yearly screening beginning at ages 75, 65, and 55 years had ICERs of $39,100/QALY, $48,900/QALY, and $96,900/QALY, respectively. Results were most sensitive to variations in hearing aid utility benefit and screening effectiveness.
LIMITATION
Input uncertainty around screening effectiveness.
CONCLUSIONS
We project that yearly hearing screening beginning at age 55+ is cost-effective by US standards.
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