美国成人听力筛查的模型预测成本效益。
Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA.
机构信息
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
出版信息
J Gen Intern Med. 2023 Mar;38(4):978-985. doi: 10.1007/s11606-022-07735-7. Epub 2022 Aug 5.
BACKGROUND
While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested.
OBJECTIVE
We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA.
DESIGN
Model-based cost-effectiveness analysis simulating Current Detection (CD) and linkage of persons with HL to hearing healthcare, compared to alternative screening schedules varying by age at first screen (45 to 75 years) and screening frequency (every 1 or 5 years). Simulated persons experience yearly age- and sex-specific probabilities of acquiring HL, and subsequent hearing aid uptake (0.5-8%/year) and discontinuation (13-4%). Quality-adjusted life-years (QALYs) were estimated according to hearing level and treatment status. Costs from a health system perspective include screening ($30-120; 2020 USD), HL diagnosis ($300), and hearing aid devices ($3690 year 1, $910/subsequent year). Data sources were published estimates from NHANES and clinical trials of adult hearing screening.
PARTICIPANTS
Forty-year-old persons in US primary care across their lifetime.
INTERVENTION
Alternative screening schedules that increase baseline probabilities of hearing aid uptake (base-case 1.62-fold; range 1.05-2.25-fold).
MAIN MEASURES
Lifetime undiscounted and discounted (3%/year) costs and QALYs and incremental cost-effectiveness ratios (ICERs).
KEY RESULTS
CD resulted in 1.20 average person-years of hearing aid use compared to 1.27-1.68 with the screening schedules. Lifetime total per-person undiscounted costs were $3300 for CD and ranged from $3630 for 5-yearly screening beginning at age 75 to $6490 for yearly screening beginning at age 45. In cost-effectiveness analysis, yearly screening beginning at ages 75, 65, and 55 years had ICERs of $39,100/QALY, $48,900/QALY, and $96,900/QALY, respectively. Results were most sensitive to variations in hearing aid utility benefit and screening effectiveness.
LIMITATION
Input uncertainty around screening effectiveness.
CONCLUSIONS
We project that yearly hearing screening beginning at age 55+ is cost-effective by US standards.
背景
尽管 60%的老年人有听力损失（HL），但大多数人从未接受过听力测试。
目的
我们旨在估计美国不同成人听力筛查时间表的长期临床和经济效果。
设计
基于模型的成本效益分析，模拟当前检测（CD）和将有 HL 的人链接到听力保健，与不同初次筛查年龄（45-75 岁）和筛查频率（每 1 年或 5 年）的替代筛查时间表进行比较。模拟人员每年经历与年龄和性别相关的获得 HL 的概率，以及随后的助听器使用率（0.5-8%/年）和停用率（13-4%）。根据听力水平和治疗状态，用质量调整生命年（QALY）来评估。从卫生系统的角度来看，成本包括筛查（30-120 美元；2020 年美元）、HL 诊断（300 美元）和助听器设备（第一年 3690 美元，随后每年 910 美元）。数据来源是 NHANES 和成人听力筛查临床试验的已发表估计。
参与者
一生中在美国初级保健中 40 岁的人。
干预措施
增加助听器使用率的基础概率的替代筛查时间表（基线为 1.62 倍；范围为 1.05-2.25 倍）。
主要测量指标
终生未贴现和贴现（3%/年）成本和 QALY 以及增量成本效益比（ICER）。
主要结果
CD 导致平均每人每年使用助听器 1.20 次，而筛查方案为 1.27-1.68 次。CD 每个人终生未贴现的人均费用为 3300 美元，5 年一次的筛查从 75 岁开始，费用为 3630 美元，每年一次的筛查从 45 岁开始，费用为 6490 美元。在成本效益分析中，每年从 75、65 和 55 岁开始的筛查的 ICER 分别为 39100 美元/QALY、48900 美元/QALY 和 96900 美元/QALY。结果对助听器效用收益和筛查效果的变化最为敏感。
局限性
筛查效果的输入不确定性。
结论
根据美国标准，我们预计从 55 岁以上开始每年进行听力筛查具有成本效益。
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