Dubno Judy R, Majumder Pranab, Bettger Janet Prvu, Dolor Rowena J, Eifert Victoria, Francis Howard W, Pieper Carl F, Schulz Kristine A, Silberberg Mina, Smith Sherri L, Walker Amy R, Witsell David L, Tucci Debara L
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Fuqua School of Business, Duke University, Durham, NC, USA.
Cost Eff Resour Alloc. 2022 Jun 25;20(1):26. doi: 10.1186/s12962-022-00360-5.
Hearing loss is a high prevalence condition among older adults, is associated with higher-than-average risk for poor health outcomes and quality of life, and is a public health concern to individuals, families, communities, professionals, governments, and policy makers. Although low-cost hearing screening (HS) is widely available, most older adults are not asked about hearing during health care visits. A promising approach to addressing unmet needs in hearing health care is HS in primary care (PC) clinics; most PC providers (PCPs) do not inquire about hearing loss. However, no cost assessment of HS in community PC settings has been conducted in the United States. Thus, this study conducted a cost-effectiveness analysis of HS using results from a pragmatic clinic trial that compared three HS protocols that differed in the level of support and encouragement provided by the PC office and the PCPs to older adults during their routine visits. Two protocols included HS at home (one with PCP encouragement and one without) and one protocol included HS in the PC office.
Direct costs of the HS included costs of: (1) educational materials about hearing loss, (2) PCP educational and encouragement time, and (3) access to the HS system. Indirect costs for in-office HS included cost of space and minimal staff time. Costs were tracked and modeled for each phase of care during and following the HS, including completion of a diagnostic assessment and follow-up with the recommended treatment plan.
The cost-effectiveness analysis showed that the average cost per patient is highest in the patient group who completed the HS during their clinic visit, but the average cost per patient who failed the HS is by far the lowest in that group, due to the higher failure rate, that is, rate of identification of patients with suspected hearing loss. Estimated benefits of HS in terms of improvements in quality of life were also far greater when patients completed the HS during their clinic visit.
Providing HS to older adults during their PC visit is cost-effective and accrues greater estimated benefits in terms of improved quality of life.
clinicaltrials.gov (Registration Identification Number: NCT02928107).
听力损失在老年人中是一种高发性疾病，与高于平均水平的健康不良后果和生活质量风险相关，是个人、家庭、社区、专业人员、政府和政策制定者关注的公共卫生问题。尽管低成本听力筛查（HS）广泛可用，但在医疗保健就诊期间，大多数老年人并未被询问听力情况。解决听力保健未满足需求的一种有前景的方法是在初级保健（PC）诊所进行HS；大多数初级保健提供者（PCP）并未询问听力损失情况。然而，美国尚未对社区PC环境中的HS进行成本评估。因此，本研究利用一项实用临床试验的结果进行了HS的成本效益分析，该试验比较了三种HS方案，这三种方案在PC办公室和PCP在老年人常规就诊期间提供的支持和鼓励水平上有所不同。两种方案包括在家进行HS（一种有PCP鼓励，一种没有），一种方案包括在PC办公室进行HS。
HS的直接成本包括：（1）关于听力损失的教育材料成本，（2）PCP的教育和鼓励时间成本，以及（3）使用HS系统的成本。办公室内HS的间接成本包括空间成本和最少的工作人员时间成本。在HS期间及之后的每个护理阶段跟踪并模拟成本，包括完成诊断评估和遵循推荐的治疗计划进行随访。
成本效益分析表明，在诊所就诊期间完成HS的患者组中，每位患者的平均成本最高，但在该组中，HS未通过的患者的平均成本是迄今为止最低的，这是由于失败率较高，即疑似听力损失患者的识别率较高。当患者在诊所就诊期间完成HS时，HS在改善生活质量方面的估计效益也大得多。
在老年人PC就诊期间为其提供HS具有成本效益，并且在改善生活质量方面产生更大的估计效益。
clinicaltrials.gov（注册识别号：NCT02928107）。
