Academic journal article Journal of Rehabilitation Research & Development

Long-Term Cost-Effectiveness of Screening Strategies for Hearing Loss

Academic journal article Journal of Rehabilitation Research & Development

Long-Term Cost-Effectiveness of Screening Strategies for Hearing Loss

Article excerpt


Hearing loss is one of the most common chronic conditions in older Americans [1-2]. The number of individuals with hearing impairment in the United States is estimated to be over 28 million [3]. The development of hearing loss is usually gradual and lacks acute symptoms, leaving the condition underdetected [4-5] and undertreated [6-7]. Thus, many patients with hearing loss do not seek treatment that can alleviate depression symptoms and diminish social isolation associated with this condition, ultimately improving quality of life [8-11]. The typical hearing aid user waits many years after the onset of hearing loss before seeking treatment. To alleviate the toll that hearing loss exacts on productivity, function, and quality of life, some authors have advocated routine hearing screening. Several screening tests can accurately detect hearing loss among elderly patients [12-14], and both the U.S. Preventive Service Task Force and the Canadian Task Force on Preventive Health Care have recommended routine screening of hearing loss in the elderly [15-16].

The Screening for Auditory Impairment-Which Hearing Assessment Test (SAI-WHAT) randomized trial evaluated the effectiveness of screening older outpatient veterans for hearing loss. The SAI-WHAT study compared three different screening strategies against no screening. The study showed that screening for hearing loss resulted in significantly more veterans who used hearing aids 1 year after screening, particularly if screened with a tone-emitting otoscope, compared with veterans who did not receive screening [17].

Information on the cost-effectiveness of hearing loss screening provides critical information for administrators and policy makers deciding to adopt a new screening strategy. No previous research has assessed costs or cost-effectiveness of hearing loss screening strategies. In this article, we assess the effect of the SAI-WHAT study screening strategies on utilization and costs of audiology care. We also examine the long-term cost-effectiveness of each of the SAI-WHAT study screening strategies.


Screening Strategies

The SAI-WHAT study was a four-group, randomized trial, including three screening strategies and one control group without screening. The three screening groups consisted of a physiologic hearing test using a tone-emitting otoscope (AudioScope, Welch Allyn; Skaneateles Falls, New York); a validated, self-administered hearing handicap questionnaire; and both screening tools used together. A detailed description of the study design, baseline screening, and main outcomes has been published elsewhere [17-18].

Tone-Emitting Otoscope Screening

For the tone-emitting otoscope screening, the examiner held the unit to the participant's ear while the participant listened to tones emitted by the device. The screening was positive if the participant did not hear a 40 dB tone at 2,000 Hz in either ear [13,19-20]. Training required to use the device was negligible. Screening time was about 2 minutes.

Hearing Handicap Questionnaire Screening

The hearing handicap questionnaire screening consisted of the self-administered Hearing Handicap Inventory for the Elderly, Screening Version. It assesses social and emotional hearing handicap [14,21], ranging from a no handicap score of 0 to a maximum handicap score of 40. A score of [greater than or equal to]10 was a positive screen. Hearing handicap questionnaire completion time was 5 minutes.

Dual Screening

The third screening strategy consisted of both the tone-emitting otoscope and the hearing handicap questionnaire. Together, they may assess complementary aspects of hearing loss [13,19]. The tone-emitting otoscope may identify those with mild hearing loss who may not have sufficient handicap to seek out and comply with treatment [19]. However, the hearing handicap questionnaire may identify motivated participants [12] but may miss those with only mild loss and miss early detection. …

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