Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina.
JAMA Health Forum. 2022 Nov 4;3(11):e224065. doi: 10.1001/jamahealthforum.2022.4065.
Adult hearing screening is not routinely performed, and most individuals with hearing loss (HL) have never had their hearing tested as adults.
To project the monetary value of future research clarifying uncertainties around the optimal adult hearing screening schedule.
DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, a validated decision model of HL (DeciBHAL-US: Decision model of the Burden of Hearing loss Across the Lifespan) was used to simulate current detection and treatment of HL vs hearing screening schedules. Key model inputs included HL incidence (0.06%-10.42%/y), hearing aid uptake (0.54%-8.14%/y), screening effectiveness (1.62 × hearing aid uptake), utility benefits of hearing aids (+0.11), and hearing aid device costs ($3690). Distributions to model parameters for probabilistic uncertainty analysis were assigned. The expected value of perfect information (EVPI) and expected value of partial perfect information (EVPPI) using a willingness to pay of $100 000 per quality-adjusted life-year (QALY) was estimated. The EVPI and EVPPI estimate the upper bound of the dollar value of future research. This study was based on 40-year-old persons over their remaining lifetimes in a US primary care setting.
Screening schedules beginning at ages 45, 55, 65, and 75 years, and frequencies of every 1 or 5 years.
The main outcomes were QALYs and costs (2020 US dollars) from a health system perspective.
The average incremental cost-effectiveness ratio for yearly screening beginning at ages 55 to 75 years ranged from $39 200 to $80 200/QALY. Yearly screening beginning at age 55 years was the optimal screening schedule in 38% of probabilistic uncertainty analysis simulations. The population EVPI, or value of reducing all uncertainty, was $8.2 to $12.6 billion varying with willingness to pay and the EVPPI, or value of reducing all screening effectiveness uncertainty, was $2.4 billion.
In this economic evaluation of US adult hearing screening, large uncertainty around the optimal adult hearing screening schedule was identified. Future research on hearing screening has a high potential value so is likely justified.
成人听力筛查并未常规进行，大多数听力损失（HL）患者从未在成年后接受过听力测试。
预测澄清成人听力筛查时间表不确定性的未来研究的货币价值。
设计、环境和参与者：在这项经济评估中，使用经过验证的 HL 决策模型（DeciBHAL-US：终身听力损失负担的决策模型）来模拟当前对 HL 的检测和治疗与听力筛查时间表的情况。关键模型输入包括 HL 发病率（0.06%-10.42%/y）、助听器使用率（0.54%-8.14%/y）、筛查效果（助听器使用率的 1.62 倍）、助听器的效用收益（+0.11）和助听器设备成本（$3690）。为概率不确定性分析分配了模型参数的分布。使用每 QALY 愿意支付 10 万美元的意愿支付，估计了完全信息的期望价值（EVPI）和部分完全信息的期望价值（EVPPI）。EVPI 和 EVPPI 估计了未来研究的美元价值上限。这项研究基于美国初级保健环境中 40 岁人群的剩余寿命。
筛查计划从 45、55、65 和 75 岁开始，频率为每年或每 5 年一次。
主要结果是从健康系统角度来看的 QALYs 和成本（2020 年美元）。
从 55 岁到 75 岁每年进行筛查的平均增量成本效益比在 39000 美元到 80200 美元/QALY 之间。在概率不确定性分析模拟的 38%中，每年从 55 岁开始筛查是最佳筛查方案。人群 EVPI，或降低所有不确定性的价值，在 82 亿美元至 126 亿美元之间变化，取决于支付意愿和 EVPPI，或降低所有筛查效果不确定性的价值，为 24 亿美元。
在这项对美国成人听力筛查的经济评估中，确定了成人听力筛查最佳时间表的不确定性很大。未来关于听力筛查的研究具有很高的潜在价值，因此是合理的。
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