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Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA

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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Funding

This study was funded by the National Institute on Deafness and Other Communication Disorders and the National Institute on Aging (3UL1-TR002553-03S3 and F30 DC019846). The funding source had no role in the design, analysis, or interpretation of the study or in the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Gillian D. Sanders Schmidler PhD.

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Dr. Dubno declares grants from the National Institutes of Health, participation on the National Institute of Deafness and Other Communication Disorders Data Safety Monitoring Board, participation on the National Institute on Aging ACHIEVE study Data Safety Monitoring Board, participation on the Board of Directors of the Hearing Health Foundation, and the Executive Council of the American Society of Audiologists.

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Borre, E.D., Dubno, J.R., Myers, E.R. et al. Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA. J GEN INTERN MED (2022). https://doi.org/10.1007/s11606-022-07735-7

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KEY WORDS

  • Adult hearing screening
  • Cost-effectiveness
  • Decision modeling