Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 4;3(11):e224065.
doi: 10.1001/jamahealthforum.2022.4065.

Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule

Ethan D Borre  1   2 , Evan R Myers  3 , Judy R Dubno  4 , Susan D Emmett  5   6 , Juliessa M Pavon  7 , Howard W Francis  5 , Osondu Ogbuoji  6   8 , Gillian D Sanders Schmidler  1   2   9
Affiliations

Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule

Ethan D Borre et al. JAMA Health Forum. .

Abstract

Importance: Adult hearing screening is not routinely performed, and most individuals with hearing loss (HL) have never had their hearing tested as adults.

Objective: 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.

Exposures: Screening schedules beginning at ages 45, 55, 65, and 75 years, and frequencies of every 1 or 5 years.

Main outcomes and measures: The main outcomes were QALYs and costs (2020 US dollars) from a health system perspective.

Results: 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.

Conclusions and relevance: 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Dubno reported grants paid to the University from the National Institutes of Health outside the submitted work and participation on the National Institute of Deafness and Other Communication Disorders Data Safety Monitoring Board, the National Institute on Aging ACHIEVE study Data Safety Monitoring Board, the Board of Directors of the Hearing Health Foundation, and the Executive Council of the American Society of Audiologists. Dr Emmett reported honoraria from hearX for speaking outside the submitted work. Dr Sanders Schmidler reported grants from Duke University during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Cost-effectiveness Acceptability Curve
The Figure depicts the probability that each simulated screening schedule is the optimal schedule (ie, the nondominated schedule with the highest effectiveness and incremental cost-effectiveness ratio under the willingness to pay) on the y-axis, across willingness to pay values ranging from $0 to $200 000 per QALY on the x-axis. QALY indicates quality-adjusted life-year; q1, yearly screening; and q5, screening every 5 years.
See this image and copyright information in PMC

References

    1. Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017;390(10111):2503-2515. doi:10.1016/S0140-6736(17)31073-5 - DOI - PubMed
    1. Goman AM, Lin FR. Prevalence of hearing loss by severity in the United States. Am J Public Health. 2016;106(10):1820-1822. doi:10.2105/AJPH.2016.303299 - DOI - PMC - PubMed
    1. Yueh B, Collins MP, Souza PE, et al. . Long-term effectiveness of screening for hearing loss: the screening for auditory impairment—which hearing assessment test (SAI-WHAT) randomized trial. J Am Geriatr Soc. 2010;58(3):427-434. doi:10.1111/j.1532-5415.2010.02738.x - DOI - PubMed
    1. Yueh B, Piccirillo JF. Screening for hearing loss in older adults: insufficient evidence does not mean insufficient benefit. JAMA. 2021;325(12):1162-1163. doi:10.1001/jama.2021.2020 - DOI - PubMed
    1. Folmer RL, Saunders GH, Vachhani JJ, et al. . Hearing health care utilization following automated hearing screening. J Am Acad Audiol. 2021;32(4):235-245. doi:10.1055/s-0041-1723041 - DOI - PMC - PubMed

Publication types