Ye Xin, Zhu Dawei, Wang Yanshang, Chen Siyuan, Gao Jiamin, Du Yali, Wang Juncheng, Zuo Huibin, Shi Xuefeng, He Ping
Institute for Global Public Policy, Fudan University, 220 Handan Road, Yangpu District, Shanghai 200433, China.
LSE-Fudan Research Centre for Global Public Policy, Fudan University, 220 Handan Road, Yangpu District, Shanghai 200433, China.
Lancet Reg Health West Pac. 2022 Sep 14;31:100594. doi: 10.1016/j.lanwpc.2022.100594. eCollection 2023 Feb.
Hearing impairment has become a major global health issue. To reduce the burden of hearing impairment, we explored impacts of the hearing aid intervention on healthcare utilization and costs.
In this randomized controlled trial, participants aged 45+ were allocated with a ratio of 1:1.5 (intervention: control). Neither the investigators nor the assessors were blinded to the allocation status. Those in the intervention group were fitted with hearing aids, and those in the control group received no care. We applied the difference-in-difference (DID) approach to examine the impacts on healthcare utilization and costs. Given that social network and age can be significant variables affecting effectiveness of the intervention, subgroup analyses by social network and age were used to explore the heterogeneity.
395 subjects were successfully recruited and randomized. 10 subjects did not meet the inclusion criteria and therefore, 385 eligible subjects (150 in the treatment group and 235 in the control group) were analyzed. The intervention significantly reduced their total healthcare costs (average treatment effect (ATE) = -1.26, 95% CI = -2.39, -0.14, = 0.028) and total out-of-pocket (OOP) healthcare costs (ATE = -1.29, 95% CI = -2.37, -0.20, = 0.021) in the 20-month follow-up. To be exact, it reduced self-medication costs (ATE = -0.82, 95% CI = -1.49, -0.15, = 0.016) and OOP self-medication costs (ATE = -0.84, 95% CI = -1.46, -0.21, = 0.009). Subgroup analysis showed that the impacts on self-medication costs and OOP self-medication costs varied by social network (ATE for self-medication costs = -0.26, 95% CI = -0.50, -0.01, = 0.041; ATE for OOP self-medication costs = -0.27, 95% CI = -0.52, -0.01, = 0.038). The impacts also varied by age groups (ATE for self-medication costs = -0.22, 95% CI = -0.40, -0.04, = 0.019; ATE for OOP self-medication costs = -0.17, 95% CI = -0.29, -0.04, = 0.010). There were no adverse events or side effects during the trial.
Hearing aid use significantly lowered self-medication costs and total healthcare costs, but had no impacts on inpatient or outpatient services utilization or costs. The impacts were manifested among people with active social network or younger age. It can be speculated that the intervention may be adapted to other similar settings in developing countries to reduce healthcare costs.
P.H. reports grants from National Natural Science Foundation of China (No. 71874005) and Major Project of the National Social Science Fund of China (No. 21&ZD187).
Chinese Clinical Trial Registry: ChiCTR1900024739.
听力障碍已成为一个主要的全球健康问题。为减轻听力障碍负担，我们探讨了助听器干预对医疗保健利用和成本的影响。
在这项随机对照试验中，45岁及以上的参与者按1:1.5的比例分配（干预组：对照组）。研究人员和评估人员均未对分配状态进行盲法处理。干预组参与者佩戴助听器，对照组参与者不接受任何护理。我们采用差分法（DID）来检验对医疗保健利用和成本的影响。鉴于社交网络和年龄可能是影响干预效果的重要变量，我们通过社交网络和年龄进行亚组分析，以探讨异质性。
成功招募并随机分配了395名受试者。10名受试者不符合纳入标准，因此，对385名符合条件的受试者（治疗组150名，对照组235名）进行了分析。在20个月的随访中，干预措施显著降低了他们的总医疗保健成本（平均治疗效果（ATE）=-1.26，95%置信区间=-2.39，-0.14，P=0.028）和总自付医疗保健成本（ATE=-1.29，95%置信区间=-2.37，-0.20，P=0.021）。确切地说，它降低了自我药疗成本（ATE=-0.82，95%置信区间=-1.49，-0.15，P=0.016）和自付自我药疗成本（ATE=-0.84，95%置信区间=-1.46，-0.21，P=0.009）。亚组分析表明，对自我药疗成本和自付自我药疗成本的影响因社交网络而异（自我药疗成本的ATE=-0.26，95%置信区间=-0.50，-0.01，P=0.041；自付自我药疗成本的ATE=-0.27，95%置信区间=-0.52，-0.01，P=0.038）。这些影响在不同年龄组中也有所不同（自我药疗成本的ATE=-0.22，95%置信区间=-0.40，-0.04，P=0.019；自付自我药疗成本的ATE=-0.17，95%置信区间=-0.29，-0.04P=0.010）。试验期间未发生不良事件或副作用。
使用助听器显著降低了自我药疗成本和总医疗保健成本，但对住院或门诊服务的利用或成本没有影响。这些影响在社交活跃或年龄较小的人群中更为明显。可以推测，该干预措施可能适用于发展中国家的其他类似环境，以降低医疗保健成本。
P.H.报告获得中国国家自然科学基金（项目编号：71874005）和中国国家社会科学基金重大项目（项目编号：21&ZD187）的资助。
中国临床试验注册中心：ChiCTR1900024739。
