Prevalence of permanent childhood hearing loss detected at the universal newborn hearing screen: Systematic review and meta-analysis.

CONTEXT: Permanent childhood hearing loss (PCHL) can affect speech, language, and wider outcomes. Adverse effects are mitigated through universal newborn hearing screening (UNHS) and early intervention. OBJECTIVE: We undertook a systematic review and meta-analysis to estimate prevalence of UNHS-detected PCHL (bilateral loss ≥26 dB HL) and its variation by admission to neonatal intensive care unit (NICU). A secondary objective was to report UNHS programme performance (PROSPERO: CRD42016051267). DATA SOURCES: Multiple electronic databases were interrogated in January 2017, with further reports identified from article citations and unpublished literature (November 2017). STUDY SELECTION: UNHS reports from very highly-developed (VHD) countries with relevant prevalence and performance data; no language or date restrictions. DATA EXTRACTION: Three reviewers independently extracted data and assessed quality. RESULTS: We identified 41 eligible reports from 32 study populations (1799863 screened infants) in 6195 non-duplicate references. Pooled UNHS-detected PCHL prevalence was 1.1 per 1000 screened children (95% confidence interval [CI]: 0.9, 1.3; I2 = 89.2%). This was 6.9 times (95% CI: 3.8, 12.5) higher among those admitted to NICU. Smaller studies were significantly associated with higher prevalences (Egger's test: p = 0.02). Sensitivity and specificity ranged from 89-100% and 92-100% respectively, positive predictive values from 2-84%, with all negative predictive values 100%. LIMITATIONS: Results are generalisable to VHD countries only. Estimates and inferences were limited by available data. CONCLUSIONS: In VHD countries, 1 per 1000 screened newborns require referral to clinical services for PCHL. Prevalence is higher in those admitted to NICU. Improved reporting would support further examination of screen performance and child demographics.

Access To Hearing Care Services Among Older Medicare Beneficiaries Using Hearing Aids.

The Over-the-Counter Hearing Aid Act of 2017 will soon allow people to purchase hearing aids without an audiologist or hearing aid dispenser acting as a go-between. Under this new arrangement there will be no guarantee that purchasers with hearing loss will have access to the hearing care services that are often needed to optimize hearing and communication with the devices. Using data for 2013 from the Medicare Current Beneficiary Survey, we examined existing barriers to accessing those services among older Medicare beneficiaries who owned and used hearing aids. Within this population, beneficiaries who were dually eligible for Medicaid had 41 percent lower odds of using hearing care services and were twice as likely to report having a lot of trouble hearing with their aids, compared to high-income Medicare beneficiaries. Existing barriers to device owners' receiving hearing care services are likely to be exacerbated when over-the-counter sales further separate the purchase of hearing aids from payment for supportive services. Coverage of hearing care services under the Medicare program should be considered to address income-related constraints to service access.

How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries.

Issue: The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Goal: Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Methods: Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Findings and Conclusions: Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.

Economic evaluation of long-term impacts of universal newborn hearing screening.

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.

Universal neonatal hearing screening program in Shanghai, China: An inter-regional and international comparison.

OBJECTIVE: By comparing the Universal Neonatal Hearing Screening (UNHS) program as implemented in Shanghai and other regions in China and countries around the world, this study makes an assessment of the Shanghai model and summarizes the experiences implementing the UNHS program, so as to provide a valuable reference for other countries or regions to carry out UNHS more effectively. Since Shanghai is one of the most developed regions in China, we also examined the relationship between economic development and the UNHS starting year and coverage rate. METHODS: The study conducted a systematic review of published studies in Chinese and English on the program status of neonatal hearing screening to compare and analyze the implementation of the UNHS program in 20 cities or provinces in China and 24 regions or countries around the world. The literature search in Chinese was conducted in the three most authoritative publication databases, CNKI (China National Knowledge Infrastructure), WANFANGDATA, and CQVIP (http://www.cqvip.com/). We searched all publications in those databases with the keywords "neonatal hearing screening" (in Chinese) between 2005 and 2014. English literature was searched using the same keywords (in English). The publication database included Medline and Web of Science, and the search time period was 2000-2014. RESULTS: Shanghai was one of the first regions in China to implement UNHS, and its coverage rate was among the top regions by international comparison. The starting time of the UNHS program had no relationship with the Gross Domestic Product (GDP) per capita in the same year. Economic level serves as a threshold for carrying out UNHS but is not a linear contributor to the exact starting time of such a program. The screening coverage rate generally showed a rising trend with the increasing GDP per capita in China, but it had no relationship with the area's GDP per capita in selected regions and countries around the world. The system design of UNHS is the key factor influencing screening coverage. Policy makers, program administrators, and cost-sharing structures are important factors that influence the coverage rates of UNHS. CONCLUSION: When to carry out a UNHS program is determined by the willingness and preference of the local government, which is influenced by the area's social, political and cultural conditions. Mandatory hearing screening and minimal-cost to no-cost intervention are two pillars for a good coverage rate of UNHS. In terms of system design, decision-making, implementation, funding and the concrete implementation plan are all important factors affecting the implementation of the UNHS.

Factors associated with persons with disability employment in India: a cross-sectional study.

BACKGROUND: Over twenty million persons with disability in India are increasingly being offered poverty alleviation strategies, including employment programs. This study employs a spatial analytic approach to identify correlates of employment among persons with disability in India, considering sight, speech, hearing, movement, and mental disabilities. METHODS: Based on 2001 Census data, this study utilizes linear regression and spatial autoregressive models to identify factors associated with the proportion employed among persons with disability at the district level. Models stratified by rural and urban areas were also considered. RESULTS: Spatial autoregressive models revealed that different factors contribute to employment of persons with disability in rural and urban areas. In rural areas, having mental disability decreased the likelihood of employment, while being female and having movement, or sight impairment (compared to other disabilities) increased the likelihood of employment. In urban areas, being female and illiterate decreased the likelihood of employment but having sight, mental and movement impairment (compared to other disabilities) increased the likelihood of employment. CONCLUSIONS: Poverty alleviation programs designed for persons with disability in India should account for differences in employment by disability types and should be spatially targeted. Since persons with disability in rural and urban areas have different factors contributing to their employment, it is vital that government and service-planning organizations account for these differences when creating programs aimed at livelihood development.

The Cost-Effectiveness of Different Hearing Screening Strategies for 50- to 70-Year-Old Adults: A Markov Model.

OBJECTIVE: To assess the cost-effectiveness of screening 50- to 70-year-old adults for hearing loss in The Netherlands. We compared no screening, telephone screening, Internet screening, screening with a handheld screening device, and audiometric screening for various starting ages and a varying number of repeated screenings. METHODS: The costs per quality-adjusted life-year (QALY) for no screening and for 76 screening strategies were analyzed using a Markov model with cohort simulation for the year 2011. Screening was deemed to be cost-effective if the costs were less than €20,000/QALY. RESULTS: Screening with a handheld screening device and audiometric screening were generally more costly but less effective than telephone and Internet screening. Internet screening strategies were slightly better than telephone screening strategies. Internet screening at age 50 years, repeated at ages 55, 60, 65, and 70 years, was the most cost-effective strategy, costing €3699/QALY. At a threshold of €20,000/QALY, this strategy was with 100% certainty cost-effective compared with current practice and with 69% certainty the most cost-effective strategy among all strategies. CONCLUSIONS: This study suggests that Internet screening at age 50 years, repeated at ages 55, 60, 65, and 70 years, is the optimal strategy to screen for hearing loss and might be considered for nationwide implementation.

Burden of Sickness Absence Due to Chronic Disease in the Dutch Workforce from 2007 to 2011.

INTRODUCTION: Chronic diseases are associated with productivity loss costs due to sickness absence. It is not always clear, however, which chronic diseases in particular are involved with how many sickness days and associated costs. OBJECTIVE: To determine the prevalence, additional days of sickness absence, and associated costs of chronic diseases among the Dutch working population from 2007 to 2011. METHODS: Prevalence of chronic diseases and additional days of sickness absence were derived from the Netherlands Working Conditions Survey (NWCS) from 2007 to 2011. The cost of each sickness absence day was based on linked personal income data. We used multiple regression analysis to derive the unconfounded additional days of sickness absence due to each chronic disease. RESULTS: Annually, approximately 37 % of the Dutch working population reported some type of chronic physical or psychological disease. No clinically relevant changes in prevalence of specific chronic diseases were observed in the studied period, nor in the number of additional sickness absence days or associated costs. The national financial burden due to sickness absence associated with chronic musculoskeletal disorders amounted to €1.3 billion annually. CONCLUSIONS: Chronic diseases result in substantial productivity loss due to sickness absence. Given the ageing population, the proposed increase in the state pension age and an increase in sedentary lifestyle and obesity, the prevalence of chronic diseases may be expected to rise. Coordinated efforts to maintain and improve the health of the working population are necessary to minimize socioeconomic consequences.

Results of a 1-year government-funded newborn hearing screening program in Taiwan.

OBJECTIVES/HYPOTHESIS: To establish an ideal operative procedure of universal newborn hearing screening and to investigate whether a government-funded program increases compliance with such screening. STUDY DESIGN: Individual cohort study. METHODS: Of the 3,373 neonates born at the Taipei City Hospital during the period August 2009 to July 2010, there were 3,361 who received hearing screening with automatic auditory brainstem response (AABR) 24 to 36 hours after birth. The cost of each procedure (US $16.70) was covered by the Taipei City Health Bureau. The control group comprised 6,582 neonates born at the same hospital during the period January 2003 to December 2004, of whom 5,749 had been screened with transient-evoked otoacoustic emission (TEOAE). The cost of each procedure (US $26.70) was paid by the parents of each newborn. RESULTS: The incidence of bilateral moderate to severe hearing impairment was 0.06% (two out of 3,361) and 0.10% (six out of 5,749) in the study and the control group, respectively. The incidence of unilateral hearing impairment was 0.09% (three out of 3,361) and 0.19% (11 out of 5,749) respectively. The coverage rate of the study was significantly higher than that of the control group (99.64% vs. 87.34%, P < .001). A significant decrease of the referral rate was achieved in the study group when compared with the control group (0.95% vs. 2.82%, P < .001). The follow-up rate of the study group was significantly higher than that of the control group (100.00% vs. 40.74%, P < .001). CONCLUSIONS: The government-funded AABR program resulted in markedly better parental compliance with newborn hearing screening than the self-pay TEOAE screening program. LEVEL OF EVIDENCE: 2b.

Societal costs of hearing disorders: a systematic and critical review of literature.

OBJECTIVE: The objective of this study was to perform a critical and systematic literature review of studies on societal costs due to hearing disorders. DESIGN: We used predefined search terms and inclusion/exclusion criteria. Systematic searches were conducted in Medline, Cochrane Library, Google Scholar, and other relevant websites. The review included studies written in English or Swedish between 1995 and the end of January 2012. STUDY SAMPLE: We identified four published studies and four reports that met the pre-defined inclusion criteria. RESULTS: Swedish cost studies primarily focused on costs of hearing aids. International studies with a societal perspective used different costing approaches and were limited to specific patient populations. Hearing disorders impact the social welfare system more than the medical care system. Indirect costs account for the major part and direct medical costs for a minor part of the total costs of hearing disorders. CONCLUSIONS: There is a need for further studies estimating societal costs for all degrees of hearing disorders, in particular since a large part of the people with hearing disorders are of working age.

Costs and health effects of screening and delivery of hearing aids in Tamil Nadu, India: an observational study.

BACKGROUND: The burden of disease of hearing disorders among adults is high, but a significant part goes undetected. Screening programs in combination with the delivery of hearing aids can alleviate this situation, but the economic attractiveness of such programs is unknown. This study aims to evaluate the population-level costs, effects and cost-effectiveness of alternative delivering hearing aids models in Tamil Nadu, India METHODS: In an observational study design, we estimated total costs and effects of two active screening programs in the community in combination with the provision of hearing aids at secondary care level, and the costs and effects of the provision of hearing aids at tertiary care level. Screening and hearing aid delivery costs were estimated on the basis of program records and an empirical assessment of health personnel time input. Household costs for seeking and undergoing hearing health care were collected with a questionnaire (see Additional file 2). Health effects were estimated on the basis of compliance with the hearing aid, and associated changes in disability, and were expressed in disability-adjusted life years (DALYs) averted. RESULTS: Active screening and provision of hearing aids at the secondary care level costs around Rs.7,000 (US$152) per patient, whereas provision of hearing aids at the tertiary care level costs Rs 5,693 (US$122) per patient. The cost per DALY averted was around RS 42,200 (US$900) at secondary care level and Rs 33,900 (US$720) at tertiary care level. The majority of people did consult other providers before being screened in the community. Costs of food and transport ranged between Rs. 2 (US$0,04) and Rs. 39 (US$0,83). CONCLUSION: Active screening and provision of hearing aids at the secondary care level is slightly more costly than passive screening and fitting of hearing aids at the tertiary care level, but seems also able to reach a higher coverage of hearing aids services. Although crude estimates indicate that both passive and active screening programs can be cautiously considered as cost-effective according to international thresholds, important questions remain regarding the implementation of the latter.

Costs of screening children for hearing disorders and delivery of hearing aids in China.

BACKGROUND: The burden of disease of hearing disorders among children is high, but a large part goes undetected. School-based screening programs in combination with the delivery of hearing aids can alleviate this situation, but the costs of such programs are unknown. AIM: To evaluate the costs of a school-based screening program for hearing disorders, among approximately 216,000 school children, and the delivery of hearing aids to 206 children at three different care levels in China. METHODS: In a prospective study design, screening and hearing aid delivery costs were estimated on the basis of program records and an empirical assessment of health personnel time input. Household costs for seeking and undergoing hearing health care were collected with a questionnaire, administered to the parents of the child. Data were collected at three study sites representing primary, secondary and tertiary care levels. RESULTS: Total screening and hearing aid delivery costs ranged between RMB70,000 (US$9,000) and RMB133,000 (US$17,000) in the three study sites. Health care cost per child fitted ranged from RMB5,900 (US$760) at the primary care level, RMB7,200 (US$940) at the secondary care level, to RMB8,600 (US$1,120) at the tertiary care level. Household costs were only a small fraction of the overall costs. Cost per child fitted ranged between RMB1,608 and RMB2,812 (US$209-US$365), depending on perspective of analysis and study site. The program was always least costly in the primary care setting. CONCLUSION: Hearing screening and the delivery of hearing aids in China is least costly in a primary care setting. Important questions remain concerning its implementation.

[Cost analysis of a universal newborn hearing screening for clinics using the State of Hesse as an example]. / Kostenanalyse des universellen Neugeborenen-Hörscreenings für Kliniken am Beispiel Hessens.

BACKGROUND: The implementation of a universal newborn hearing screening (UNHS) in Germany in 2009 requires a realistic cost calculation for health insurance companies and participating clinics MATERIAL AND METHODS: Screening costs from 60 Hessian clinics were analyzed over 2.5 years whereby 94,203 children had been screened either with a 2-step (TEOAE, AABR) or a 1-step procedure (AABR). RESULTS: The TEOAE-AABR screening at EUR 13.16 per child was more cost-efficient. For a population with a high rate of at-risk babies a sole AABR device with screening costs of EUR 16.87 presents a more efficient alternative. High quality of screening performance and qualification of screening staff markedly reduced total cost. Overhead costs for tracking, quality assurance, control of completeness, and securing structural screening requirements, considered as essential screening costs, were calculated at EUR 4.00 per child. The total costs in Hesse would therefore be EUR 17.16 per child for TEOAE-AABR screening and EUR 20.87 per child for an AABR screening. CONCLUSION: In a mixed calculation which can be cautiously extrapolated from the Hessian data for Germany as a whole, costs would be EUR 18.40 per registered child.

Cost-effectiveness of hearing aids in the hearing-impaired elderly: a probabilistic approach.

OBJECTIVE: Hearing aids are the principal tool for rehabilitation of hearing loss, one of the most prevalent impairments among elderly adults, but cost-utility ratings for hearing aid use are limited. DESIGN: Cost-effectiveness analysis. SETTING AND PATIENTS: A multistate Markov model was constructed to model 50- to 80-year-old patients moving between states, including normal hearing, mild, moderate, or severe hearing loss. Parameters assigned in the model are partly derived from the Medline source (1966-2005) and partly from data on hearing-impaired elders (n = 96) in a tertiary care center in Taiwan. To address uncertainty, most of the parameters were specified by distributions, rather than base-case values. A probabilistic approach with Monte Carlo simulations was performed to produce an acceptability curve, showing the probabilities of being cost-effective given threshold values of willingness to pay (WTP). MAIN OUTCOME MEASURES: Hearing-related quality-adjusted life-years and cost in US dollars and Euros. RESULTS: The incremental costs for gaining an additional hearing-related quality-adjusted life-years in women and men were US $13,615 (Euro 10,826) and 9,702 (Euro 7,715), respectively. The probability of being cost-effective increased to 53% in women and 65% in men given a WTP of US $12,000 (Euro 9,542). The probabilities of being cost-effective to reach plateau were 67% for women and 78% for men given a WTP of US $20,000 (Euro 15,904). CONCLUSION: By modeling different degrees of hearing loss with a multistate model, hearing aid use was demonstrated to be a cost-effective strategy to rehabilitate the hearing-impaired elderly. These results can assist policy makers in allocating health resources appropriately and effectively.

Willingness to accept versus willingness to pay in a discrete choice experiment.

OBJECTIVES: Our main objective was to compare willingness to accept (WTA) and willingness to pay (WTP) in a discrete choice experiment on hearing aid provision. Additionally, income effect and endowment effect were explored as possible explanations for the disparity between WTA and WTP, and the impact of using a WTA and/or WTP format to elicit monetary valuations on the net benefit of the new organization of hearing aid provision was examined. METHODS: Choice sets were based on five attributes: performer of the initial assessment; accuracy of the initial assessment; duration of the pathway; follow-up at the ear, nose, and throat specialist; and costs. Persons with hearing complaints randomly received a WTP (costs defined as extra payment) or WTA (costs defined as discount) version of the experiment. In the versions, except for the cost attribute, all choice sets were equal. RESULTS: The cost coefficient was statistically significantly higher in the WTP format. Marginal WTA was statistically significantly higher than marginal WTP for the attributes accuracy and follow-up. Disparity was higher in the high educational (as proxy for income) group. We did not find proof of an experience endowment effect. Implementing the new intervention would only be recommended when using WTP. CONCLUSIONS: WTA exceeds WTP, also in a discrete choice experiment. As this affects monetary valuations, more research on when to use a payment or a discount in the cost attribute is needed before discrete choice results can be used in cost-benefit analyses.

Infant hearing screening: effects of timeline.

OBJECTIVES: Universal infant hearing screening using otoacoustic emission and auditory brain-stem response audiometry is widely administered to attain the goals of early identification of, and intervention for hearing impairment. Concerns regarding screening specificity have, however, been raised. False positives may result from vernix occlusion in the ear canal or transient middle ear effusion, and can result in substantial costs to health care systems. The current study investigates the effects of age and time interval between tests on hearing assessment results. SETTING & PARTICIPANTS: Three hundred and seventeen positive screens from a 2-stage distortion product otoacoustic emission (DPOAE) screening programme in Hong Kong, who subsequently received diagnostic auditory brainstem response (ABR) assessment and monitoring, were investigated. MAIN OUTCOME MEASURES: Differences in diagnostic ABR results were compared among infants of different ages at tests, and with different time lapses after DPOAE screening. The proportion of those having persistent hearing impairment, conductive loss and impairment of moderate degree or above, were also compared. RESULTS: A significantly higher rate of normal ABR thresholds (60%versus 24%) was noted in infants assessed after age 50 days, and in infants diagnostically assessed with a time lapse of over 20 days post-DPOAE screening (65%versus 42%). CONCLUSIONS: Delaying diagnostic ABR assessment may reveal a higher percentage of normal thresholds, and hence probably higher specificity. Time delay may allow for spontaneous resolution of transient outer and middle ear conditions. However, the goals of early identification and intervention, as well as possible parental anxiety with delayed assessment, should also be considered when reviewing infant hearing screening schedules.

Public health impact of hearing impairment and disability.

UNLABELLED: This presentation of the public health impact of hearing impairment highlights the important elements of interaction between the disability and community. OBJECTIVES: Retrospective study to identify the size of the problem of hearing loss, illustrating not only the magnitude but also the serious effect of the lack of reliable data concerning this matter. It highlights the challenges met within a mid-economy community regarding the handling of the impact of the disability. The Egyptian data is given as an example of the situation in a mid-economy community. STUDY DESIGN: A brief introduction of some epidemiological factors of hearing impairment is presented including the size of the problem in Egypt. Data of the neonatal hearing screening program of the Audiology Unit, Ain Shams University, is presented. The impact of the disability is then discussed in relation to the age of onset and the degree and type of hearing loss. This is followed by the description of the nature and effect of the disability in the different age groups. A discussion of the various factors that may modify the capability of the community to deal with such disability follows. This includes various economic indices with their possible limitations on the part of the community. Such a briefing illustrates the challenges met in the rehabilitation of the deaf and the hearing-impaired in a developing mid-economy country. The broad lines of the management of the problem both at the prophylactic as well as the rehabilitative levels are discussed. A final remark on recommendations and possible future development in a developing country is presented.