Kloosterman Nicole, Griffith Kevin N, Yancey Kristen, Jayawardena Asitha Dl, Netterville James
Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
Am J Otolaryngol Head Neck Surg. 2021;4(10):1161.
Approximately 8.9 million children in Sub-Saharan Africa have disabling hearing loss, accounting for 11% of the global child healthcare hearing costs. For children living in Low- and Middle-Income Countries (LMICs), 75% of hearing loss is preventable.
We evaluate the overall intervention and expansion costs of a humanitarian, pediatric hearing health and screening program in Malindi, Kilifi County, Kenya. A cost analysis is conducted from the provider perspective, identifying the mean cost incurred for each case of newly identified hearing loss. Estimates were made for 3 different cost scenarios. A one-way sensitivity analysis and probabilistic sensitivity analysis using Monte Carlo simulation determined the impact of variations in individual cost parameters. These results were used to project scale-up costs to achieve sub-county expansion of the program.
155 children ages 5 to 16 years old were screened, of which 5.8% were diagnosed with hearing impairment. The total cost for implementation in four schools was $6,783 USD, thus a mean cost of $212 per diagnosis of hearing loss. The highest proportion of costs were recurrent costs of resident travel (27.9%), capital costs for providing audiometric testing (25.3%), and equipment maintenance (18.7%). Expansion of an exclusively CHW-run program across all 77 primary public schools in Malindi is projected to be $130,573 (range $119,352 to $142,240).
We provide relevant cost-estimation for an expansion of an intervention which identified higher than average rates of hearing loss. Humanitarian aid plays a key role in the sustainability and feasibility of expanding this program.
撒哈拉以南非洲地区约有890万儿童患有致残性听力损失，占全球儿童听力保健费用的11%。对于生活在低收入和中等收入国家（LMICs）的儿童来说，75%的听力损失是可以预防的。
我们评估了肯尼亚基利菲县马林迪一项人道主义儿科听力健康与筛查项目的总体干预和扩展成本。从提供者的角度进行成本分析，确定每例新确诊听力损失的平均成本。对3种不同的成本情景进行了估计。使用蒙特卡洛模拟进行的单因素敏感性分析和概率敏感性分析确定了各个成本参数变化的影响。这些结果被用于预测扩大该项目规模以实现县以下扩展所需的成本。
对155名5至16岁的儿童进行了筛查，其中5.8%被诊断为听力障碍。在四所学校实施该项目的总成本为6783美元，因此每例听力损失诊断的平均成本为212美元。成本占比最高的是驻地工作人员差旅费（27.9%）、提供听力测试的资本成本（25.3%）和设备维护成本（18.7%）。预计在马林迪所有77所公立小学全面推行由社区卫生工作者（CHW）专门负责的项目，成本将达到130573美元（范围为119352美元至142240美元）。
我们为一项发现听力损失率高于平均水平的干预措施的扩展提供了相关成本估计。人道主义援助在扩大该项目的可持续性和可行性方面发挥着关键作用。
