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Verstappen G, Foulon I, Van den Houte K, Heuninck E, Van Overmeire B, Gordts F, Topsakal V. Analysis of congenital hearing loss after neonatal hearing screening. Front Pediatr 2023; 11:1153123. [PMID: 37255573 PMCID: PMC10226668 DOI: 10.3389/fped.2023.1153123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Neonates undergo neonatal hearing screening to detect congenital hearing loss at an early stage. Once confirmed, it is necessary to perform an etiological workup to start appropriate treatment. The study objective was to assess the different etiologies, risk factors, and hearing results of infants with permanent hearing loss and to evaluate the efficacy and consequences of the different screening devices over the last 21 years. Methods We conducted a single-center retrospective cohort analysis for all neonatal hearing screening program referrals and performed an etiological workup in case of confirmed hearing loss. We analyzed the evolution of the etiological protocols based on these results. Results The governmental neonatal hearing screening program referred 545 infants to our center. Hearing loss was confirmed in 362 (66.4%) infants and an audiological workup was performed in 458 (84%) cases. 133 (24.4%) infants were diagnosed with permanent hearing loss. Ninety infants (56 bilateral and 34 unilateral) had sensorineural hearing loss, and the degree was predominantly moderate or profound. The most common etiology in bilateral sensorineural hearing loss was a genetic etiology (32.1%), and in unilateral sensorineural hearing loss, an anatomical abnormality (26.5%). Familial history of hearing loss was the most frequently encountered risk factor. Conclusion There is a significant number of false positives after the neonatal hearing screening. Permanent hearing loss is found only in a limited number of infants. During the 21 years of this study, we noticed an increase in etiological diagnoses, especially genetic causes, due to more advanced techniques. Genetic causes and anatomical abnormalities are the most common etiology of bilateral and unilateral sensorineural hearing loss, respectively, but a portion remains unknown after extensive examinations.
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Affiliation(s)
- Gill Verstappen
- Department of Otorhinolaryngology—Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Health Campus, Brussels, Belgium
| | - Ina Foulon
- Department of Otorhinolaryngology—Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Health Campus, Brussels, Belgium
| | - Kelsey Van den Houte
- Department of Otorhinolaryngology—Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Health Campus, Brussels, Belgium
| | - Emilie Heuninck
- Department of Otorhinolaryngology—Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Health Campus, Brussels, Belgium
| | - Bart Van Overmeire
- Medical Department/Preventive Medicine, Kind en Gezin-Opgroeien, Vlaamse Overheid, Brussels, Belgium
| | - Frans Gordts
- Department of Otorhinolaryngology—Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Health Campus, Brussels, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology—Head and Neck Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Health Campus, Brussels, Belgium
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Pitathawatchai P, Chaichulee S, Wannaro W, Pongprawat P. Cost-effectiveness analysis on implementing newborn hearing screening programmes in a low- to middle-income country. Int J Audiol 2023; 62:79-88. [PMID: 35075981 DOI: 10.1080/14992027.2021.2014072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To analyse the cost-effectiveness (CE) of implementing different newborn hearing screening protocols in a low- to middle-income country. DESIGN A decision analytical model with a 78-year time horizon. STUDY SAMPLE Direct medical, direct non-medical and indirect costs were collected from 126 subjects in southern Thailand. Various protocols involving universal newborn hearing screening (UNHS) and targeted newborn hearing screening (TNHS), using two technologies, namely automated otoacoustic emissions (aOAEs) and automated auditory brainstem responses (aABRs), were evaluated. Incremental cost-effectiveness ratios (ICERs) were calculated for all protocols in United States dollars (US$)/quality-adjusted life year (QALY) gained. Also, probabilistic sensitivity analyses with 1000 trials for each specific protocol were performed. RESULTS The ICERs of UNHS with aOAE, UNHS with aABR, TNHS with aABR and UNHS with optimised baseline parameters were 3702, 3545, 1545 and 2483 US$/QALY gained, respectively. With the CE threshold of 5000 US$/QALY gained, the chances of ICERs to be cost-effective for UNHS with aOAE, UNHS with aABR, TNHS with aABR and UNHS with optimised baseline parameters were 72, 77, 93 and 94%, respectively. CONCLUSIONS All screening protocols were considered as cost-effective, and a very high chance of being cost-effective for UNHS could be achieved when certain baseline parameters were optimised.
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Affiliation(s)
- Pittayapon Pitathawatchai
- Department of Otolaryngology Head & Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Sitthichok Chaichulee
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Institute of Biomedical Engineering, Prince of Songkla University, Hat Yai, Thailand
| | - Wirawan Wannaro
- Department of Otolaryngology Head & Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Patchanok Pongprawat
- Department of Otolaryngology Head & Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Joshi B D, Ramkumar V, Nair LS, Kuper H. Early hearing detection and intervention (EHDI) programmes for infants and young children in low-income and middle-income countries in Asia: a systematic review. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001752. [PMID: 36720503 PMCID: PMC9890799 DOI: 10.1136/bmjpo-2022-001752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/30/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Early hearing detection and intervention (EHDI) measures initiated in high-income countries (HICs) were attempted in low-income and middle-income countries (L&MICs). However, information regarding the models of EHDI, context-specific adaptations made to strategies and outcomes are not known. AIMS The aims of this systematic review were to identify the various models of EHDI used in Asian L&MICs in the published scientific literature and to describe their efficacy and validity. METHODS The studies were eligible if the programme was from Asian L&MICs, implemented for children below 6 years of age and published between 2010 and 2021. Google Scholar, PubMed, Web of Science, Scopus, EBSCOHost and EBSCO-CINAHL were used to find articles. Data were extracted from each selected article, and the risk of bias was assessed. The search results were summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. For primary outcomes, narrative synthesis was used, and forest plots were generated for secondary outcomes. RESULTS In all, 82 studies were included, and these studies were divided into two categories: newborn and infant screening programmes and screening programmes for older children. Predominantly, a two-stage objective otoacoustic emission (Distortion Product/Transient Evoked) or automated auditory brainstem response screening, followed by a detailed auditory brainstem response to confirm the hearing loss, was used in newborn and infant screening programmes. Audiologists were the most frequent screening personnel. Screening of older children was mostly done by otolaryngologists, school instructors and nurses. They performed a single-stage pure tone audiometry screening followed by a detailed examination. CONCLUSION The screening tools and protocols used were similar to those used in HICs. However, no uniform protocols were followed within each country. Long-term viability of EHDI programmes was not known as there was limited information on impact outcomes such as cost-benefit. PROSPERO REGISTRATION NUMBER CRD42021240341.
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Affiliation(s)
- Deepashree Joshi B
- Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamilnadu, India.,Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamilnadu, India
| | - Vidya Ramkumar
- Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamilnadu, India
| | - Lekha S Nair
- Department of Audiology and Speech Language Pathology, National Institute of Speech and Hearing, Thiruvananthapuram, Kerala, India
| | - Hannah Kuper
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Werkineh HB, fröschl U, Gellaneh WL, Untiso FL, Negash LG, Ridder GJ. Magnitude and Factors Associated with Refer Results of Newborn Hearing Screening at Academic Tertiary Level Hospital, Addis Ababa, Ethiopia. Int J Otolaryngol 2022; 2022:1-8. [PMID: 36303722 PMCID: PMC9596266 DOI: 10.1155/2022/1977184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hearing impairment is a leading cause of disability worldwide. Early identification and early intervention of hearing loss can prevent further disability in the development of speech, language, cognition, and other developmental domains. This study aimed to determine the magnitude and factors associated with the refer results of newborn hearing screening at an academic tertiary hospital. Methods An institution-based time series cross-sectional study was conducted with a calculated sample size of 368 newborns selected by systemic random sampling from a total of 2087 newborns born in SPHMMC during the study period. Two stage screening protocol was conducted using Transient Evoked Otoacoustic Emission (TEOAE) on the first, followed by TEOAE and Auditory Brainstem Reflex (ABR) as a second stage for newborns with refer results. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Bivariate and multivariate analyses between dependent and independent variables were performed using binary logistic regression with a significance level of P value <0.05. Result Of the total sample size of 368 newborns, 62% (228) passed the first TEOAE and 38% (140) yielded refer results. From 121 who came for follow-up screening (6–28 days), 49.5% (60) passed the second TEOAE and 50.5% (61) had refer results. AABR screening of 61 newborns yielded pass in 11.5% (7) and refer result in 88.5% (54) newborns. Noise (AOR= 4.746, 95% CI 2.505–8.992, P < 0.001), vernix caseosa (AOR= 19.745, 95% CI 9.057–43.043, P < 0.001), and very low birth weight (AOR= 4.338, 95% CI 1.338–14.067, P=0.015) were found to be significantly associated with the refer rate of the first TEOAE test. Noise (AOR 39.445, 95% CI 5.974–260.467, P < 0.001) and neonatal jaundice (AOR 21.633, 95% CI 1.540–303.994, P=0.023) were significantly associated with the follow-up screening refer result of TEOAE. Repeat TEOAE has decreased the refer rate from 38.0% (140/368) to 17.5% (61/349), 19 of which were lost to follow-up. AABR has decreased the overall refer rate from 17.5% to 15.5% (54/349). Conclusion This study shows a significant number of newborns (15.5%) who need diagnostic audiologic work-up and may need intervention. Vernix caseosa and noise are avoidable factors, but newborns with jaundice and very low birth weight should be sent to ENT for screening.
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Hsieh WH, Lin HC. Follow-up on children with suspected bilateral congenital hearing loss identified through universal newborn hearing screening program in Taiwan: A national-based population study. Int J Pediatr Otorhinolaryngol 2022; 157:111141. [PMID: 35461145 DOI: 10.1016/j.ijporl.2022.111141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This investigation was to ascertain the performance of the UNHS in Taiwan. METHODS The predefined questionnaire was delivered on the phone in 2016. The descriptive analysis was applied to the research data. 941 neonates in birth cohorts 2013-2014 who were documented as a bilateral referral in the national UNHS tracking system were targeted. The respondents were either caregivers or family members. RESULTS 40.3% of 941 children were lost to follow-up, and 66.24% of 363 children were diagnosed with SNHL. 45.15% of 163 children used hearing amplification device(s). 77.46% of hearing amplification device users and 7.51% of non-users participated in the auditory training courses. By six months of age, 38.51% and 22.58% of children diagnosed with bilateral SNHL commenced the hearing amplification device fitting and the auditory training courses, respectively. CONCLUSIONS More efforts are needed to enhance the performance of the UNHS to achieve national goals stated in the 2014 Taiwan UNHS Revised Guidelines and the well-known benchmarks set by the JCIH in 2007. The development of an electronic tracking system for storing and sharing information on the follow-up on children with congenital hearing loss was as significant as the improvements in the understanding of early hearing detection and intervention of the public and stakeholders.
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Affiliation(s)
- Wen Hui Hsieh
- Department of Audiology and Speech - Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Hung Ching Lin
- Department of Audiology and Speech - Language Pathology, Mackay Medical College, New Taipei City, Taiwan; Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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Faramarzi M, Babakhani Fard S, Bayati M, Jafarlou F, Parhizgar M, Rezaee M, Keshavarz K. Cost-effectiveness analysis of hearing screening program for primary school children in southern Iran, Shiraz. BMC Pediatr 2022; 22:318. [PMID: 35637460 PMCID: PMC9150379 DOI: 10.1186/s12887-022-03384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hearing loss is the second most common chronic disease, the diagnosis and treatment of which can be faster through screening. In addition, early interventions will save significant costs for the education and health systems. Therefore, the present study aimed to evaluate the cost-effectiveness of hearing screening for primary school children in Shiraz. METHODS This cross-sectional economic evaluation of cost-effectiveness was conducted from the perspective of the health system. The study population comprised all seven-year-old children participating in the screening program in Shiraz. The present study dealt only with direct costs. The expected costs and outcomes, as well as the ICER index were estimated using the decision tree model. The study outcomes included averted disability-adjusted life years (DALY) and true identification of hearing loss cases. The robustness of the results was evaluated using the one-way sensitivity analysis. The TreeAge 2020 and Excel 2016 software were also used to analyze the collected data. RESULTS The hearing screening data obtained during 6 years (2015-2020) showed that every year, an average of 22,853 children in Shiraz were examined for hearing, of which 260 were true positive (%1.1). The costs of screening and lack of screening were estimated at $30.32 Purchasing Power Parity (PPP) and $13.75 PPP per child, respectively. The averted DALY due to performing hearing screening was estimated at 7 years for each child. The ICER was positive and equal to $ 0.06 PPP for the identified cases and $ 2.37 PPP per averted DALY. The sensitivity analysis confirmed the robustness of the results. CONCLUSIONS According to the results, although hearing screening for primary school children had more costs and effectiveness, it was considered cost-effective. Therefore, universal screening with high quality and accuracy is recommended.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Department of Otorhinolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Babakhani Fard
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Jafarlou
- Department of Audiology, School of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Parhizgar
- Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. .,Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Sharma R, Gu Y, Sinha K, Ching TYC, Marnane V, Gold L, Wake M, Wang J, Parkinson B. An Economic Evaluation of Australia's Newborn Hearing Screening Program: A Within-Study Cost-Effectiveness Analysis. Ear Hear 2021. [PMID: 34772837 DOI: 10.1097/AUD.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Hearing loss is one of the most prevalent congenital disorders among children. Many countries have implemented universal newborn hearing screening (UNHS) for the early diagnosis and treatment of hearing loss. Despite widespread implementation, the value for money of UNHS is unclear due to lack of cost and outcomes data from rigorous study designs. The objective of this research is to conduct a within-study cost-effectiveness analysis of UNHS compared with targeted screening (targeting children with risk factors of hearing loss) from the Australian healthcare system perspective. This evaluation is the first economic evaluation to assess the cost-effectiveness of UNHS compared to targeted screening using real-world data from a natural experiment. DESIGN The evaluation assumed the Australian healthcare system perspective and considered a time horizon of 5 years. Utilities were estimated using responses to the Health Utilities Index Mark III. Screening costs were estimated based on the Victorian Infant Hearing Screening Program. Ongoing costs were estimated based on administrative data, while external data sources were used to estimate costs related to hearing services. Missing data were handled using the multiple imputation method. Outcome measures included quality-adjusted life years (QALYs) and four language and communication-related outcomes: Peabody Picture Vocabulary Test, Wechsler Nonverbal Scale of Ability, Progressive Achievement Test, and comprehensive, expressive, and total language scores based on the Preschool Language Scale. RESULTS On average, the UNHS cost an extra Australian dollar (A$)22,000 per diagnosed child and was associated with 0.45 more QALYs per diagnosed child compared with targeted screening to 5 years, resulting in an incremental cost-effectiveness ratio (ICER) of A$48,000 per QALY gained. The ICERs for language outcomes lay between A$3,900 (for expressive language score) and A$83,500 per one-point improvement in language score (for Wechsler Nonverbal Scale of Ability). UNHS had a 69% probability of being more cost-effective compared to targeted screening at a willingness to pay threshold of A$60,000 per QALY gained. ICERs were most sensitive to the screening costs. CONCLUSIONS The evaluation demonstrated the usefulness of a within-study economic evaluation to understand the value for money of the UNHS program in the Australian context. Findings from this evaluation suggested that screening costs were the key driver of cost-effectiveness results. Most outcomes were not significantly different between UNHS and targeted screening groups. The ICER may be overestimated due to the short follow-up period. Further research is warranted to include long-term resource use and outcome data, late diagnosis, transition and remission between severity levels, and timing of diagnosis and treatment.
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Verkleij ML, Heijnsdijk EAM, Bussé AML, Carr G, Goedegebure A, Mackey AR, Qirjazi B, Uhlén IM, Sloot F, Hoeve HLJ, de Koning HJ. Cost-Effectiveness of Neonatal Hearing Screening Programs: A Micro-Simulation Modeling Analysis. Ear Hear 2021; 42:909-916. [PMID: 33306547 PMCID: PMC8221716 DOI: 10.1097/aud.0000000000000981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Early detection of neonatal hearing impairment moderates the negative effects on speech and language development. Universal neonatal hearing screening protocols vary in tests used, timing of testing and the number of stages of screening. This study estimated the cost-effectiveness of various protocols in the preparation of implementation of neonatal hearing screening in Albania.
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Affiliation(s)
- Mirjam L Verkleij
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrea M L Bussé
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gwen Carr
- Independent Consultant in Early Hearing Detection, Intervention and Family Centered Practice, London, United Kingdom
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Allison R Mackey
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Birkena Qirjazi
- Department of Ear, Nose and Throat Diseases-Ophthalmology, University of Tirana, Tirana, Albania
| | - Inger M Uhlén
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Frea Sloot
- Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hans L J Hoeve
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Borre ED, Diab MM, Ayer A, Zhang G, Emmett SD, Tucci DL, Wilson BS, Kaalund K, Ogbuoji O, Sanders GD. Evidence gaps in economic analyses of hearing healthcare: A systematic review. EClinicalMedicine 2021; 35:100872. [PMID: 34027332 PMCID: PMC8129894 DOI: 10.1016/j.eclinm.2021.100872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hearing loss is a common and costly medical condition. This systematic review sought to identify evidence gaps in published model-based economic analyses addressing hearing loss to inform model development for an ongoing Lancet Commission. METHODS We searched the published literature through 14 June 2020 and our inclusion criteria included decision model-based cost-effectiveness analyses that addressed diagnosis, treatment, or prevention of hearing loss. Two investigators screened articles for inclusion at the title, abstract, and full-text levels. Data were abstracted and the studies were assessed for the qualities of model structure, data assumptions, and reporting using a previously published quality scale. FINDINGS Of 1437 articles identified by our search, 117 unique studies met the inclusion criteria. Most of these model-based analyses were set in high-income countries (n = 96, 82%). The evaluated interventions were hearing screening (n = 35, 30%), cochlear implantation (n = 34, 29%), hearing aid use (n = 28, 24%), vaccination (n = 22, 19%), and other interventions (n = 29, 25%); some studies included multiple interventions. Eighty-six studies reported the main outcome in quality-adjusted or disability-adjusted life-years, 24 of which derived their own utility values. The majority of the studies used decision tree (n = 72, 62%) or Markov (n = 41, 35%) models. Forty-one studies (35%) incorporated indirect economic effects. The median quality rating was 92/100 (IQR:72-100). INTERPRETATION The review identified a large body of literature exploring the economic efficiency of hearing healthcare interventions. However, gaps in evidence remain in evaluation of hearing healthcare in low- and middle-income countries, as well as in investigating interventions across the lifespan. Additionally, considerable uncertainty remains around productivity benefits of hearing healthcare interventions as well as utility values for hearing-assisted health states. Future economic evaluations could address these limitations. FUNDING NCATS 3UL1-TR002553-03S3.
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Affiliation(s)
- Ethan D. Borre
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Mohamed M. Diab
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Austin Ayer
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Gloria Zhang
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Susan D. Emmett
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Debara L. Tucci
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, United States
| | - Blake S. Wilson
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
- Department of Electrical & Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Kamaria Kaalund
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Osondu Ogbuoji
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham NC, United States
| | - Gillian D. Sanders
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke University Clinical Research Institute, Duke University School of Medicine, Durham NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Corresponding author at: Gillian Sanders Schmidler, PhD, Duke-Robert J. Margolis, MD, Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC 27708-0120.
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Cacciatore P, Visser LA, Buyukkaramikli N, van der Ploeg CPB, van den Akker-van Marle ME. The Methodological Quality and Challenges in Conducting Economic Evaluations of Newborn Screening: A Scoping Review. Int J Neonatal Screen 2020; 6:ijns6040094. [PMID: 33238605 PMCID: PMC7712813 DOI: 10.3390/ijns6040094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cost-effectiveness (CEA) and cost-utility analyses (CUA) have become popular types of economic evaluations (EE) used for evidence-based decision-making in healthcare resource allocation. Newborn screening programs (NBS) can have significant clinical benefits for society, and cost-effectiveness analysis may help to select the optimal strategy among different screening programs, including the no-screening option, on different conditions. These economic analyses of NBS, however, are hindered by several methodological challenges. This study explored the methodological quality in recent NBS economic evaluations and analyzed the main challenges and strategies adopted by researchers to deal with them. METHODS A scoping review was conducted according to PRISMA methodology to identify CEAs and CUAs of NBS. The methodological quality of the retrieved studies was assessed quantitatively using a specific guideline for the quality assessment of NBS economic evaluations, by calculating a general score for each EE. Challenges in the studies were then explored using thematic analysis as a qualitative synthesis approach. RESULTS Thirty-five studies met the inclusion criteria. The quantitative analysis showed that the methodological quality of NBS economic evaluations was heterogeneous. Lack of clear description of items related to results, discussion, and discounting were the most frequent flaws. Methodological challenges in performing EEs of neonatal screenings include the adoption of a long time horizon, the use of quality-adjusted life years as health outcome measure, and the assessment of costs beyond the screening interventions. CONCLUSIONS The results of this review can support future economic evaluation research, aiding researchers to develop a methodological guidance to perform EEs aimed at producing solid results to inform decisions for resource allocation in neonatal screening.
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Affiliation(s)
- Pasquale Cacciatore
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Laurenske A. Visser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (L.A.V.); (N.B.)
| | - Nasuh Buyukkaramikli
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands; (L.A.V.); (N.B.)
| | | | - M. Elske van den Akker-van Marle
- Unit Medical Decision Making, Department of Biomedical Datasciences, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
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Han JH, Yi DW, Lee J, Chang WD, Lee HJ. Development of a Smartphone-Based Digits-in-Noise Test in Korean: a Hearing Screening Tool for Speech Perception in Noise. J Korean Med Sci 2020; 35:e163. [PMID: 32476302 PMCID: PMC7261694 DOI: 10.3346/jkms.2020.35.e163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/22/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The digits-in-noise (DiN) test is a speech-in-noise test to measure speech recognition threshold in noise adaptively. Herein, we aimed to develop the Korean version of the DiN test to provide a useful hearing screening tool for clinical as well as research purposes. METHOD Spoken monosyllabic digits from 0 to 9 were recorded by a female speaker. The test list was constructed such that each digit was placed in three different positions. An optimization procedure was conducted to equate the audibility of each digit. After the optimization, the smartphone application for the Korean DiN (K-DiN) test was developed. For the adaptive measurement procedure, 180 new DiN triplets separated into six lists of 30 were created. Mean speech recognition threshold values for each list and session were measured to examine the test-retest and training effects of the test materials. In addition, speech recognition threshold values measured by different devices were compared to determine whether the speech recognition threshold levels differed. RESULTS Optimization results showed that the mean speech recognition threshold and slope were ?11.55 dB signal-to-noise ratio and 10.21%/dB, respectively, which are comparable to levels shown in different-language versions of the DiN test. The results of the test-retest and training effects revealed no significant differences among the test sessions and lists. Additionally, the mean speech recognition threshold values measured by four different devices were not different, indicating the reliability of the test materials. CONCLUSION We believe this study is the first to attempt to develop a K-DiN test. Our results indicate that this test can be used as a potentially reliable hearing screening tool.
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Affiliation(s)
- Ji Hye Han
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Dong Woon Yi
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Jihyun Lee
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Won Du Chang
- Department of Computer Engineering, Pukyong National University, Busan, Korea
| | - Hyo Jeong Lee
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
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Sharma R, Gu Y, Ching TYC, Marnane V, Parkinson B. Economic Evaluations of Childhood Hearing Loss Screening Programmes: A Systematic Review and Critique. Appl Health Econ Health Policy 2019; 17:331-357. [PMID: 30680698 PMCID: PMC7279710 DOI: 10.1007/s40258-018-00456-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Permanent childhood hearing loss is one of the most common birth conditions associated with speech and language delay. A hearing screening can result in early detection and intervention for hearing loss. OBJECTIVES To update and expand previous systematic reviews of economic evaluations of childhood hearing screening strategies, and explore the methodological differences. DATA SOURCES MEDLINE, Embase, the Cochrane database, National Health Services Economic Evaluation Database (NHS EED), the Health Technology Assessment (HTA) database, and Canadian Agency for Drugs and Technologies in Health's (CADTH) Grey matters. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Economic evaluations reporting costs and outcomes for both the intervention and comparator arms related to childhood hearing screening strategies. RESULTS Thirty evaluations (from 29 articles) were included for review. Several methodological issues were identified, including: few evaluations reported outcomes in terms of quality-adjusted life years (QALYs); none estimated utilities directly from surveying children; none included disutilities and costs associated with adverse events; few included costs and outcomes that differed by severity; few included long-term estimates; none considered acquired hearing loss; some did not present incremental results; and few conducted comprehensive univariate or probabilistic sensitivity analysis. Evaluations published post-2011 were more likely to report QALYs and disability-adjusted life years (DALYs) as outcome measures, include long-term treatment and productivity costs, and present incremental results. LIMITATIONS We were unable to access the economic models and, although we employed an extensive search strategy, potentially not all relevant economic evaluations were identified. CONCLUSIONS AND IMPLICATIONS Most economic evaluations concluded that childhood hearing screening is value for money. However, there were significant methodological limitations with the evaluations.
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Affiliation(s)
- Rajan Sharma
- Macquarie University Centre for the Health Economy, Sydney, NSW, Australia.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Sydney, NSW, Australia
- Department of Economics and Related Studies, University of York, York, UK
| | - Teresa Y C Ching
- National Acoustic Laboratories, Australian Hearing Hub, Sydney, NSW, Australia
| | - Vivienne Marnane
- National Acoustic Laboratories, Australian Hearing Hub, Sydney, NSW, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Sydney, NSW, Australia
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Abstract
OBJECTIVE The objective of this systematic review was to identify and assess the quality of published economic decision-analytic models within atopic eczema against best practice guidelines, with the intention of informing future decision-analytic models within this condition. METHODS A systematic search of the following online databases was performed: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, EconLit, Scopus, Health Technology Assessment, Cost-Effectiveness Analysis Registry and Web of Science. Papers were eligible for inclusion if they described a decision-analytic model evaluating both the costs and benefits associated with an intervention or prevention for atopic eczema. Data were extracted using a standardised form by two independent reviewers, whilst quality was assessed using the model-specific Philips criteria. RESULTS Twenty-four models were identified, evaluating either preventions (n = 12) or interventions (n = 12): 14 reported using a Markov modelling approach, four utilised decision trees and one a discrete event simulation, whilst five did not specify the approach. The majority, 22 studies, reported that the intervention was dominant or cost effective, given the assumptions and analytical perspective taken. Notably, the models tended to be short-term (16 used a time horizon of ≤1 year), often providing little justification for the limited time horizon chosen. The methodological and reporting quality of the studies was generally weak, with only seven studies fulfilling more than 50% of their applicable Philips criteria. CONCLUSIONS This is the first systematic review of decision models in eczema. Whilst the majority of models reported favourable outcomes in terms of the cost effectiveness of the new intervention, the usefulness of these findings for decision-making is questionable. In particular, there is considerable scope for increasing the range of interventions evaluated, for improving modelling structures and reporting quality.
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Affiliation(s)
- Emma McManus
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Nick Levell
- Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
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Chorozoglou M, Mahon M, Pimperton H, Worsfold S, Kennedy CR. Societal costs of permanent childhood hearing loss at teen age: a cross-sectional cohort follow-up study of universal newborn hearing screening. BMJ Paediatr Open 2018; 2:e000228. [PMID: 29637192 PMCID: PMC5887866 DOI: 10.1136/bmjpo-2017-000228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/10/2018] [Accepted: 01/14/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate the effects in adolescence of bilateral permanent childhood hearing loss (PCHL) > 40 dB and of exposure to universal newborn hearing screening (UNHS) on societal costs accrued over the preceding 12 months. DESIGN SETTING PARTICIPANTS An observational cohort study of a sample of 110 adolescents aged 13-20 years, 73 with PCHL and 37 in a normally hearing comparison group (HCG) closely similar in respect of place and date of birth to those with PCHL, drawn from a 1992-1997 cohort of 157 000 births in Southern England, half of whom had been exposed to a UNHS programme. INTERVENTION Birth in periods with and without UNHS. OUTCOME MEASURES Resource use and costs in the preceding 12-month period, estimated from interview at a mean age of 16.9 years and review of medical records. Effects on costs were examined in regression models. RESULTS Mean total costs for participants with PCHL and the HCG were £15 914 and £5883, respectively (difference £10 031, 95% CI £6460 to £13 603), primarily driven by a difference in educational costs. Compared with the HCG, additional mean costs associated with PCHL of moderate, severe and profound severity were £5916, £6605 and £18 437, respectively. The presence of PCHL and an additional medical condition (AMC) increased costs by £15 385 (95% CI £8532 to £22 238). An increase of one unit in receptive language z-score was associated with £1616 (95% CI £842 to £2389) lower costs. Birth during periods of UNHS was not associated with significantly lower overall costs (difference £3594, 95% CI -£2918 to £10 106). CONCLUSIONS The societal cost of PCHL was greater with more severe losses and in the presence of AMC and was lower in children with superior language scores. There was no statistically significant reduction in costs associated with birth in periods with UNHS. TRIAL REGISTRATION NUMBER ISRCTN03307358, pre-results.
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Affiliation(s)
| | - Merle Mahon
- Language and Cognition Research Department, University College London, London, UK
| | | | - Sarah Worsfold
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Colin R Kennedy
- Faculty of Medicine, University of Southampton, Southampton, UK.,University Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Grosse SD, Mason CA, Gaffney M, Thomson V, White KR. What Contribution Did Economic Evidence Make to the Adoption of Universal Newborn Hearing Screening Policies in the United States? Int J Neonatal Screen 2018; 4:25. [PMID: 30123850 PMCID: PMC6094389 DOI: 10.3390/ijns4030025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Universal newborn hearing screening (UNHS), when accompanied by timely access to intervention services, can improve language outcomes for children born deaf or hard of hearing (D/HH) and result in economic benefits to society. Early Hearing Detection and Intervention (EHDI) programs promote UNHS and using information systems support access to follow-up diagnostic and early intervention services so that infants can be screened no later than 1 month of age, with those who do not pass their screen receiving diagnostic evaluation no later than 3 months of age, and those with diagnosed hearing loss receiving intervention services no later than 6 months of age. In this paper, we first document the rapid roll-out of UNHS/EHDI policies and programs at the national and state/territorial levels in the United States between 1997 and 2005. We then review cost analyses and economic arguments that were made in advancing those policies in the United States. Finally, we examine evidence on language and educational outcomes that pertain to the economic benefits of UNHS/EHDI. In conclusion, although formal cost-effectiveness analyses do not appear to have played a decisive role, informal economic assessments of costs and benefits appear to have contributed to the adoption of UNHS policies in the United States.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop E-87, Atlanta, GA 30341, USA;
| | - Craig A Mason
- College of Education and Human Development, University of Maine, Orono, ME 00469, USA;
| | - Marcus Gaffney
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop E-87, Atlanta, GA 30341, USA;
| | - Vickie Thomson
- Department of Otolaryngology, University of Colorado Denver, Denver, CO 80045, USA;
| | - Karl R White
- National Center for Hearing Assessment and Management (NCHAM), Utah State University, Logan, UT 84322, USA;
- Department of Psychology, Utah State University, Logan, UT 84322, USA
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Chen X, Yuan M, Lu J, Zhang Q, Sun M, Chang F. ASSESSMENT OF UNIVERSAL NEWBORN HEARING SCREENING AND INTERVENTION IN SHANGHAI, CHINA. Int J Technol Assess Health Care 2017; 33:206-14. [PMID: 28583223 DOI: 10.1017/S0266462317000344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the universal newborn hearing screening (UNHS) and intervention program in Shanghai, China. METHODS This study included the quantitative analyses of the UNHS-Shanghai database in 2002-12 and qualitative assessment of the program. The Otoacoustic Emissions and the Automated Auditory Brainstem Evoked Responses tests were conducted in screening. The costs and benefits were calculated based on the number of participants in each stage. The short-term and long-term periods were defined as from birth to 15 years of age or to death (82-year-olds), respectively. Sensitivity analyses were conducted. RESULTS A total 1,574,380 newborns were included, representing 93.6 percent of all eligible babies in Shanghai during the study period. The prevalence of newborn hearing loss was 1.66‰. The short-term/long-term program costs were ¥488.5 million (US$75.52 million)/¥1.08 billion (US$167.12 million), and the short-term/long-term program benefit was ¥980.1 million (US$151.53 million)/¥8.13 billion (US$1.26 billion). The program benefit was greater than its cost if the proportion of hearing-loss children enrolled in regular schools was no less than 41.4 percent of all hearing impaired children, as well as if the wage growth rate ranged from 3 percent to 8 percent. Qualitative results also suggested that stakeholders strongly supported this program. CONCLUSIONS The universal newborn hearing screening and intervention program in Shanghai is justified in terms of the resource input in the long run, although there is still room for further improvement with respect to educational rehabilitation and a better infrastructure system.
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Saki N, Bayat A, Hoseinabadi R, Nikakhlagh S, Karimi M, Dashti R. Universal newborn hearing screening in southwestern Iran. Int J Pediatr Otorhinolaryngol 2017; 97:89-92. [PMID: 28483258 DOI: 10.1016/j.ijporl.2017.03.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The implementation of Neonatal Hearing Screening (NHS) program is still at the preliminary stage particularly in developing countries despite the burden of permanent congenital and early-onset hearing impairment. The purpose of this study was to report results for universal newborn NHS in a cohort of children born in the southwestern region of Iran, as part of a national screening program set up by the Iranian National Health System. METHODS During this cross-sectional study, which took place between March 2013 and April 2016, healthy newborns were screened using transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem responses (AABRs) methods at several points in time as early as possible after birth. Screening followed a two-stage strategy and newborns referred after the second-stage screening were scheduled for diagnostic evaluation. RESULTS A total of 92,521 newborns were screened in the urban (n = 67,780) and rural (n = 24,741) regions. Hearing impairment was confirmed in 223 (2.41 per 1000) newborns. One hundred forty-one (1.52 per 1000) of these newborns were affected bilaterally. More than 87% of these infants (195/223) showed a sensorineural hearing loss, while the defect was found to be conductive in 12 cases (P < 0.001). Of the 223 cases with hearing loss, 28 (12.5%) infants had auditory neuropathy. The majority of the infants, in both urban and rural regions, showed severe hearing impairment. We did not observe any significant difference among the incidences associated with gender (p = 0.29). CONCLUSION Our results demonstrated that universal newborn hearing screening program is an adequate program for southwestern of Iran with high coverage, low referral rate, and good follow-up rate.
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Affiliation(s)
- Nader Saki
- Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Arash Bayat
- Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Reza Hoseinabadi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheila Nikakhlagh
- Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Majid Karimi
- Department of Audiology, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.
| | - Rezvan Dashti
- Musculoskeletal Research Center, School of Rehabilitation, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Abstract
Congenital hearing loss (hearing loss that is present at birth) is one of the most prevalent chronic conditions in children. In the majority of developed countries, neonatal hearing screening programmes enable early detection; early intervention will prevent delays in speech and language development and has long-lasting beneficial effects on social and emotional development and quality of life. A diagnosis of hearing loss is usually followed by a search for an underlying aetiology. Congenital hearing loss might be attributed to environmental and prenatal factors, which prevail in low-income settings; congenital infections, particularly cytomegalovirus infection, are also a common risk factor for hearing loss. Genetic causes probably account for the majority of cases in developed countries; mutations can affect any component of the hearing pathway, in particular, inner ear homeostasis (endolymph production and maintenance) and mechano-electrical transduction (the conversion of a mechanical stimulus into electrochemical activity). Once the underlying cause of hearing loss is established, it might direct therapeutic decision making and guide prevention and (genetic) counselling. Management options include specific antimicrobial therapies, surgical treatment of craniofacial abnormalities and implantable or non-implantable hearing devices. An improved understanding of the pathophysiology and molecular mechanisms that underlie hearing loss and increased awareness of recent advances in genetic testing will promote the development of new treatment and screening strategies.
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Affiliation(s)
- Anna M. H. Korver
- Department of Pediatrics, St. Antonius Hospital, PO box 2500, 3430 EM Nieuwegein, The Netherlands
| | - Richard J. H. Smith
- Molecular Otolaryngology and Renal Research Laboratories and the Genetics PhD Program, University of Iowa, Iowa City, Iowa, United States
| | - Guy Van Camp
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Mark R. Schleiss
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Maria A. K. Bitner-Glindzicz
- Genetics and Genomic Medicine Programme, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Lawrence R. Lustig
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Medical Center, New York, New York, United States
| | - Shin-ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - An N. Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Abstract
OBJECTIVE Little is known about the long-term efficacious and economic impacts of universal newborn hearing screening (UNHS). DESIGN An analytical Markov decision model was framed with two screening strategies: UNHS with transient evoked otoacoustic emission (TEOAE) test and automatic acoustic brainstem response (aABR) test against no screening. By estimating intervention and long-term costs on treatment and productivity losses and the utility of life years determined by the status of hearing loss, we computed base-case estimates of the incremental cost-utility ratios (ICURs). The scattered plot of ICUR and acceptability curve was used to assess the economic results of aABR versus TEOAE or both versus no screening. STUDY SAMPLE A hypothetical cohort of 200,000 Taiwanese newborns. RESULTS TEOAE and aABR dominated over no screening strategy (ICUR = $-4800.89 and $-4111.23, indicating less cost and more utility). Given $20,000 of willingness to pay (WTP), the probability of being cost-effective of aABR against TEOAE was up to 90%. CONCLUSIONS UNHS for hearing loss with aABR is the most economic option and supported by economically evidence-based evaluation from societal perspective.
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Affiliation(s)
- Shu-Ti Chiou
- a Institute of Public Health , National Yang-Ming University , Taipei , Taiwan
| | - Hou-Ling Lung
- b Department of Pediatric , Mackay Memorial Hospital , Hsin-Chu , Taiwan.,c Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health , National Taiwan University , Taipei , Taiwan
| | - Li-Sheng Chen
- d School of Oral Hygiene, College of Oral Medicine , Taipei Medical University , Taipei , Taiwan
| | - Amy Ming-Fang Yen
- d School of Oral Hygiene, College of Oral Medicine , Taipei Medical University , Taipei , Taiwan
| | - Jean Ching-Yuan Fann
- e Department of Health Industry Management, School of Healthcare Management , Kainan University , Tao-Yuan , Taiwan , and
| | - Sherry Yueh-Hsia Chiu
- f Department of Health Care Management, College of Management , Chang Gung University , Tao-Yuan , Taiwan
| | - Hsiu-Hsi Chen
- c Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health , National Taiwan University , Taipei , Taiwan
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Abstract
OBJECTIVE The Affordable Care Act requires most health plans to cover the federal Recommended Uniform Screening Panel of newborn screening (NBS) tests with no cost sharing. However, state NBS programs vary widely in both the number of mandated tests and their funding mechanisms, including a combination of state laboratory fees, third-party billing, and other federal and state funding. We assessed the potential impact of the Affordable Care Act coverage mandate on states' NBS funding. METHOD We performed an extensive review of the refereed literature, federal and state agency reports, relevant organizations' websites, and applicable state laws and regulations; interviewed 28 state and federal officials from August to December 2014; and then assessed the interview findings manually. RESULTS Although a majority of states had well-established systems for including laboratory-based NBS tests in bundled charges for newborn care, billing practices for critical congenital heart disease and newborn hearing tests were less uniform. Most commonly, birthing facilities either prepaid the costs of laboratory-based tests when acquiring the filter paper kits, or the facilities paid for the tests when the kits were submitted. Some states had separate arrangements for billing Medicaid, and smaller facilities sometimes contracted with hearing test vendors that billed families separately. CONCLUSION Although the Affordable Care Act coverage mandate may offset some state NBS funding for the screenings themselves, federal support is still required to assure access to the full range of NBS program services. Limiting reimbursement to the costs of screening tests alone would undermine the common practice of using screening charges to fund follow-up services counseling, and medical food or formula, particularly for low-income families.
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Affiliation(s)
- Julia F Costich
- University of Kentucky, Department of Health Policy and Management, Lexington, KY
| | - Andrea L Durst
- University of Pittsburgh, Department of Human Genetics, Pittsburgh, PA
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Abstract
OBJECTIVE Identify variables associated with paediatric access to cochlear implants (CIs). DESIGN Part 1. Trends over time for age at CI surgery (N = 802) and age at hearing aid (HA) fitting (n = 487) were examined with regard to periods before, during, and after newborn hearing screening (NHS). Part 2. Demographic factors were explored for 417 children implanted under 3 years of age. Part 3. Pre-implant steps for the first 20 children to receive CIs under 12 months were examined. RESULTS Part 1. Age at HA fitting and CI surgery reduced over time, and were associated with NHS implementation. Part 2. For children implanted under 3 years, earlier age at HA fitting and higher family socio-economic status were associated with earlier CI. Progressive hearing loss was associated with later CIs. Children with a Connexin 26 diagnosis received CIs earlier than children with a premature / low birth weight history. Part 3. The longest pre-CI steps were Step 1: Birth to diagnosis/identification of hearing loss (mean 16.43 weeks), and Step 11: MRI scans to implant surgery (mean 15.05 weeks) for the first 20 infants with CIs under 12 months. CONCLUSION NHS implementation was associated with reductions in age at device intervention in this cohort.
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Affiliation(s)
- Shani Dettman
- a The University of Melbourne, Department of Audiology and Speech Pathology , Parkville, Victoria , Australia ;,b The Royal Victorian Eye and Ear Hospital , East Melbourne, Victoria , Australia ;,c The HEARing CRC , Carlton, Victoria , Australia
| | - Dawn Choo
- a The University of Melbourne, Department of Audiology and Speech Pathology , Parkville, Victoria , Australia ;,b The Royal Victorian Eye and Ear Hospital , East Melbourne, Victoria , Australia ;,c The HEARing CRC , Carlton, Victoria , Australia
| | - Richard Dowell
- a The University of Melbourne, Department of Audiology and Speech Pathology , Parkville, Victoria , Australia ;,b The Royal Victorian Eye and Ear Hospital , East Melbourne, Victoria , Australia ;,c The HEARing CRC , Carlton, Victoria , Australia
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Wake M, Ching TY, Wirth K, Poulakis Z, Mensah FK, Gold L, King A, Bryson HE, Reilly S, Rickards F. Population Outcomes of Three Approaches to Detection of Congenital Hearing Loss. Pediatrics 2016; 137:peds.2015-1722. [PMID: 26704085 PMCID: PMC4702017 DOI: 10.1542/peds.2015-1722] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Universal newborn hearing screening was implemented worldwide largely on modeled, not measured, long-term benefits. Comparative quantification of population benefits would justify its high cost. METHODS Natural experiment comparing 3 population approaches to detecting bilateral congenital hearing loss (>25 dB, better ear) in Australian states with similar demographics and services: (1) universal newborn hearing screening, New South Wales 2003-2005, n = 69; (2) Risk factor screening (neonatal intensive care screening + universal risk factor referral), Victoria 2003-2005, n = 65; and (3) largely opportunistic detection, Victoria 1991-1993, n = 86. Children in (1) and (2) were followed at age 5 to 6 years and in (3) at 7 to 8 years. Outcomes were compared between states using adjusted linear regression. RESULTS Children were diagnosed younger with universal than risk factor screening (adjusted mean difference -8.0 months, 95% confidence interval -12.3 to -3.7). For children without intellectual disability, moving from opportunistic to risk factor to universal screening incrementally improved age of diagnosis (22.5 vs 16.2 vs 8.1 months, P < .001), receptive (81.8 vs 83.0 vs 88.9, P = .05) and expressive (74.9 vs 80.7 vs 89.3, P < .001) language and receptive vocabulary (79.4 vs 83.8 vs 91.5, P < .001); these nonetheless remained well short of cognition (mean 103.4, SD 15.2). Behavior and health-related quality of life were unaffected. CONCLUSIONS With new randomized trials unlikely, this may represent the most definitive population-based evidence supporting universal newborn hearing screening. Although outperforming risk factor screening, school entry language still lagged cognitive abilities by nearly a SD. Prompt intervention and efficacy research are needed for children to reach their potential.
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Affiliation(s)
- Melissa Wake
- Murdoch Childrens Research Institute, Parkville, Australia; Royal Children's Hospital, Parkville, Australia; The University of Melbourne, Parkville, Australia;
| | - Teresa Y.C. Ching
- National Acoustic Laboratories, Australian Hearing, North Ryde, Australia;,The HEARing Cooperative Research Centre, The University of Melbourne, Parkville, Australia
| | - Karen Wirth
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Zeffie Poulakis
- Murdoch Childrens Research Institute, Parkville, Australia;,Royal Children’s Hospital, Parkville, Australia
| | - Fiona K. Mensah
- Murdoch Childrens Research Institute, Parkville, Australia;,Royal Children’s Hospital, Parkville, Australia;,The University of Melbourne, Parkville, Australia
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Australia; and
| | | | | | - Sheena Reilly
- Murdoch Childrens Research Institute, Parkville, Australia;,Royal Children’s Hospital, Parkville, Australia;,The University of Melbourne, Parkville, Australia
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Chan KT, Wong EC, Law CW, Chong HM, McPherson B. Improving newborn hearing screening: Are automated auditory brainstem response ear inserts an effective option? Int J Pediatr Otorhinolaryngol 2015; 79:1920-5. [PMID: 26412459 DOI: 10.1016/j.ijporl.2015.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/05/2015] [Accepted: 09/08/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Universal newborn hearing screening is an established practice among Hong Kong public hospitals using a 2-stage automated auditory brainstem response (AABR) screening protocol. To enhance overall efficiency without sacrificing program accuracy, cost reduction in terms of replacing the initial ear coupler-based screening with a more economical ear insert-based screening procedure was considered. This study examined the utility of an insert-based AABR initial screening approach and the projected cost-effectiveness of a combined probe-based plus follow-up ear coupler AABR screening procedure. METHODS Following prenatal maternal consent, newborn hearing screening was conducted with 167 healthy neonates using a cross-sectional, repeated measures study design. The neonates were screened with AABR sequentially; using ear coupler and ear probe (insert) procedures, in both ears, with two different but comparable AABR instruments. Testing took place in the antenatal ward of a department of obstetrics and gynaecology, at a large public hospital. RESULTS With the specific combination of instruments deployed for this study insert-based AABR screening generated a five-fold higher rescreen rate and took an additional 50% screening time compared to coupler-based AABR screening. Although the cost of consumables used in a 2-stage AABR screening protocol would reduce by 9.87% if the combined procedure was implemented, the findings indicated AABR screening when conducted with an ear probe has reduced utility compared with conventional ear coupler screening. CONCLUSIONS Significant differences may occur in screening outcomes when changes are made to coupler method. Initiating a 2-stage AABR screening protocol with an ear insert technique may be impracticable in newborn nurseries given the greater number of false positive cases generated by this approach in the present study and the increased time required to carry out an insert-based procedure.
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Ching TYC. Is Early Intervention Effective in Improving Spoken Language Outcomes of Children With Congenital Hearing Loss? Am J Audiol 2015; 24:345-8. [PMID: 26649545 DOI: 10.1044/2015_aja-15-0007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/15/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this research forum article was to present research findings on the effectiveness of early intervention for improving outcomes of children with congenital hearing loss. METHOD The method involved a narrative overview of recent findings from the Longitudinal Outcomes of Children with Hearing Impairment study. RESULTS Early intervention, either in the form of Results: Early intervention, either in the form of amplification or cochlear implantation, was associated with higher language scores. Maternal education and communication mode used during early intervention were also significant contributors to child outcomes. Early performance predicted later language development. CONCLUSION Early intervention is effective in improving early language outcomes, at a population level.
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Affiliation(s)
- Teresa Y. C. Ching
- National Acoustic Laboratories, Australian Hearing, Sydney, Australia
- HEARing CRC, Australia
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Gupta S, Sah S, Som T, Saksena M, Yadav CP, Sankar MJ, Thakar A, Agarwal R, Deorari AK, Paul VK. Challenges of Implementing Universal Newborn Hearing Screening at a Tertiary Care Centre from India. Indian J Pediatr 2015; 82:688-93. [PMID: 25652547 DOI: 10.1007/s12098-015-1688-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To report experience of implementing universal newborn hearing screening (UNHS) in a tertiary care neonatal unit, identify risk factors associated with failed two-step automated acoustic brainstem response (AABR) screen and evaluate cost of AABR. METHODS This was a prospective study of UNHS outcomes of all live births with two step AABR using BERAphone MB11®. Outcome measures were screening coverage, refer, pass and lost to follow up rates and cost of AABR using micro-costing method. To identify risk factors for failed screening, authors performed multivariate logistic regression with failed two-step AABR screen as dependent variable and baseline risk factors significant on univariate analysis as predictors. RESULTS Screening coverage was moderate (84 %), with 2265 of total 2700 eligible infants screened with initial AABR (mean gestation 37.2 ± 2.3 wk; birth weight 2694 ± 588 g; 305 received nursery care). A total of 273 of 2265 infants were "refer" on first screen. Second screen was done on 233, of which 58 were "refer". Of these, 35 underwent conventional ABR, of which 5 were diagnosed to have hearing impairment. Only 2 could get hearing aid. Overall, a total of 2197 (81.4 %) infants passed, 496 (18.4 %; excluding 2 deaths) were lost to follow up at various stages, and 5 (0.2 %) were diagnosed with hearing impairment, all of whom were high risk. Average cost of AABR was INR 276 per test. No factor emerged as significant on multivariate analysis. CONCLUSIONS UNHS is feasible to implement, but significant lost to follow up and non-linkage with appropriate rehabilitation services limit its utility. Cost effectiveness of UNHS compared to high risk based screening needs to be determined.
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Affiliation(s)
- Shuchita Gupta
- Newborn Health Knowledge Centre (NHKC), Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery (Eskander), University of Toronto, Toronto, Ont.; Archie's Cochlear Implant Lab (Papsin), and Department of Otolaryngology - Head and Neck Surgery (Papsin), The Hospital for Sick Children, Toronto, Ont.
| | - Blake C Papsin
- Department of Otolaryngology - Head and Neck Surgery (Eskander), University of Toronto, Toronto, Ont.; Archie's Cochlear Implant Lab (Papsin), and Department of Otolaryngology - Head and Neck Surgery (Papsin), The Hospital for Sick Children, Toronto, Ont
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Okano T, Iwai N, Taniguchi M, Ito J. A Clinical Study on 106 Infant Cases Who Received Detailed Hearing Tests after Newborn Hearing Screening. ACTA ACUST UNITED AC 2014; 117:1249-57. [DOI: 10.3950/jibiinkoka.117.1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Langer A, Brockow I, Nennstiel-Ratzel U, Menn P. The cost-effectiveness of tracking newborns with bilateral hearing impairment in Bavaria: a decision-analytic model. BMC Health Serv Res 2012; 12:418. [PMID: 23170955 PMCID: PMC3536686 DOI: 10.1186/1472-6963-12-418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 11/20/2012] [Indexed: 11/29/2022] Open
Abstract
Background Although several countries, including Germany, have established newborn hearing screening programmes for early detection and treatment of newborns with hearing impairments, nationwide tracking systems for follow-up of newborns with positive test results until diagnosis of hearing impairment have often not been implemented. However, a recent study on universal newborn hearing screening in Bavaria showed that, in a high proportion of newborns, early diagnosis was only possible with the use of a tracking system. The aim of this study was, therefore, to assess the cost-effectiveness of tracking newborns with bilateral hearing impairment in Bavaria. Methods Data from a Bavarian pilot project on newborn hearing screening and Bavarian newborn hearing screening facilities were used to assess the cost-effectiveness of the inclusion of a tracking system within a newborn hearing screening programme. A model-based cost-effectiveness analysis was conducted. The time horizon of the model was limited to the newborn hearing screening programme. Costs of the initial hearing screening test and subsequent tests were included, as well as costs of diagnosis and costs of tracking. The outcome measure of the economic analysis was the cost per case of bilateral hearing impairment detected. In order to reflect uncertainty, deterministic and probabilistic sensitivity analyses were performed. Results The incremental cost-effectiveness ratio of tracking vs. no tracking was €1,697 per additional case of bilateral hearing impairment detected. Conclusions Compared with no tracking, tracking resulted in more cases of bilateral hearing impairment detected as well as higher costs. If society is willing to pay at least €1,697 per additional case of bilateral hearing impairment detected, tracking can be recommended.
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Affiliation(s)
- Astrid Langer
- Section Quality of Health Care, Health Economics, Health System Analysis, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058, Erlangen, Germany.
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Affiliation(s)
- Alex R Kemper
- Duke Clinical Research Institute and Department of Pediatrics, 2400 Pratt Street, Room 0311 Terrace Level, Durham, NC 27705, USA.
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