A hearing bolt-on item increased the measurement properties of the EQ-5D-5L in a community-based hearing loss screening program.

OBJECTIVE: To investigate the measurement properties of a hearing item ('bolt-on') added to the EQ-5D-5L descriptive system. METHODS: Cross-sectional data on the EQ-5D-5L descriptive system with the addition of a hearing bolt-on item, namely, 'I have no/slight/moderate/severe/extreme problems hearing', was collected through face-to-face interviews with 418 participants of a community-based hearing loss screening program in Singapore. The distribution of responses to the EQ-5D and the hearing items were compared in terms of the proportion of 'no problems' and the Shannon index (H'). The measurement properties of the hearing item were assessed by testing its correlation with the hearing thresholds in dBHL; and with the standard EQ-5D items. The properties were also evaluated by comparing the proportion of 'full health' in participants with different hearing severities between standard and hearing bolt-on EQ-5D-5L; and the ability in identifying the participants between the standard EQ-5D-5L index score and the level sum score (LSS) of the hearing bolt-on system. RESULTS: Compared to the standard EQ-5D items, the hearing item has a lower proportion of 'no problems' (80.1% vs. 80.9-97.9%); more evenly-distributed responses (H' value: 0.92 vs. 0.18-0.87); and much stronger correlation with the hearing thresholds (|r|: 0.322 and 0.325 vs. 0.008-0.139). It generally has a weak correlation with EQ-5D items (|r|: 0.055-0.160); and reduces the proportion of 'full health' for the participants with different hearing functions with the percentage reduction varying from 6.6 to 22.7%. The LSS is more discriminative than the standard EQ-5D-5L index score as well (F-statistic: 12.71 and 13.93 vs.4.06 and 4.70). CONCLUSIONS: A hearing bolt-on to EQ-5D-5L can validly measure hearing severities and is likely to increase the sensitivity of the resultant preference-based EQ-5D index to hearing loss.

Cost-utility analysis of hearing aid device for older adults in the community: a delayed start study.

BACKGROUND: Hearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. This study assessed the cost-effectiveness of HA for older adults who were volunteered to be screened for hearing loss in a community-based mobile hearing clinic (MHC). METHODS: Participants with (1) at least moderate hearing loss (≥40 dB HL) in at least one ear, (2) no prior usage of HA, (3) no ear related medical complications, and (4) had a Mini-Mental State Examination score ≥ 18 were eligible for this study. Using a delayed-start study design, participants were randomized into the immediate-start (Fitted) group where HA was fitted immediately or the delayed-start (Not Fitted) group where HA fitting was delayed for three months. Cost utility analysis was used to compare the cost-effectiveness of being fitted with HA combined with short-term, aural rehabilitation with the routine care group who were not fitted with HA. Incremental cost effectiveness ration (ICER) was computed. Health Utility Index (HUI-3) was used to measure utility gain, a component required to derive the quality adjusted life years (QALY). Total costs included direct healthcare costs, direct non-healthcare costs and indirect costs (productivity loss of participant and caregiver). Demographic data was collected during the index visit to MHC. Cost and utility data were collected three months after index visit and projected to five years. RESULTS: There were 264 participants in the Fitted group and 163 participants in the Not Fitted group. No between-group differences in age, gender, ethnicity, housing type and degree of hearing loss were observed at baseline. At 3 months, HA fitting led to a mean utility increase of 0.12 and an ICER gain of S$42,790/QALY (95% CI: S$32, 793/QALY to S$62,221/QALY). At five years, the ICER was estimated to be at S$11,964/QALY (95% CI: S$8996/QALY to S$17,080/QALY) assuming 70% of the participants continued using the HA. As fewer individuals continued using their fitted HA, the ICER increased. CONCLUSIONS: HA fitting can be cost-effective and could improve the quality of life of hearing-impaired older individuals within a brief period of device fitting. Long term cost-effectiveness of HA fitting is dependent on its continued usage.

Mandarin Speech Perception Tests for Malaysian Chinese Children / Jurnal Sains Kesihatan Malaysia

The study aimed to develop Mandarin speech perception tests for Malaysian Chinese children. Two tests were developed which were the Syllabic Pattern Perception Test (SPPT) and the Tone Perception Test (TPT). Both tests were designed for children aged between three to six years-old. A total of 80 normal hearing children aged 3 years to 6 years and 11 months from several kindergartens around Kuala Lumpur and Ipoh participated in this study. Results showed that the mean scores for the SPPT did not differ significantly across age (p > 0.05), possibly due to a ceiling effect. Although the SPPT showed relatively low test-retest and inter-rater Spearman correlation coefficients (r = 0.68 for correct syllable pattern response and r = 0.38 for correct item response), the scores were highly repeatable in both test-retest and interrater conditions. For the TPT, the mean scores of five and six year old children were significantly higher than three year old subjects while the mean score of four year old subjects was significantly poorer than the six years old. The test-retest and inter-rater reliability were high and the coefficients approximated 0.80 (p < 0.05). For both tests, gender and dialects or languages used as the second language did not have significant effect on the test scores. Content validity evidence was also collected from a group of panelists. In conclusion, SPPT and TPT are reliable and valid Mandarin speech tests to be used on Malaysian Chinese children who speak Mandarin.