Liu CF (COE, Seattle), Collins MP
(COE, Seattle), Souza PE
(University of Washington), Heagerty PJ
(University of Washington), Yueh B
(University of Minnesota)
Hearing loss in the elderly is under-detected and under-treated, but it is not clear if routine hearing screening is a cost-effective way to identify patients motivated to seek and adhere to treatment to improve long-term hearing outcomes. This study examined cost-effectiveness of three hearing screening strategies.
We randomized 2,305 veterans aged 50 or older from outpatient hospital settings to receive no hearing screening, or screening with a self-administered questionnaire (Hearing Handicap Inventory for the Elderly [HHIE-S]), a physiologic test (AudioScope), or both. The long-term hearing outcome measure was hearing aid use one year after screening. Improved quality of life was defined as a 6-point increase in the inner EAR measure. We assessed the audiology costs, including screening, visits, hearing aids and batteries, in VA and non-VA care. Incremental cost-effectiveness was defined as the cost of creating an additional hearing aid user through a particular screening strategy, compared to the no-screening arm.
Positive hearing loss screening rates were 18.6%, 59.2%, and 63.6% for the AudioScope, HHIE-S, and combined screening, respectively. Compared to the no-screening arm (3.3%), all screening arms had significantly higher rates of long-term hearing aid use (6.3% for AudioScope arm, 4.1% for HHIE-S arm, 7.3% for combined arm, p < 0.01). The screening cost was $1.31/person for an AudioScope test and $0.60/person for a HHIE-S test. The incremental costs were $40 (95%CI = -$7-$91), $33 (95%CI = -$5-$71), and $68 (95%CI = $26-$113) for the AudioScope, HHIE-S, and combined screening arms compared to the no-screening arm. The incremental cost-effectiveness was $1,386 (95%CI = -$803-$3,746) for the AudioScope, $2,995 (95%CI = -$21,013-$23,170) for the HHIE-S, and $1,682 (95%CI = $856-2,589) for the combined arms. The AudioScope arm had greater improvement in quality of life than the other two screening arms.
The Audioscope appeared to be the most cost-effective approach to achieving long-term hearing aid use, although the long-term use rate was slightly lower than the combined arm.
Hearing loss screening is low cost and potentially effective at improving outcomes and quality of life. Clinical managers and policy makers can use these results to plan for hearing loss screening strategies.