Dataset Information

Costs of screening children for hearing disorders and delivery of hearing aids in China.

ABSTRACT:

Background

The burden of disease of hearing disorders among children is high, but a large part goes undetected. School-based screening programs in combination with the delivery of hearing aids can alleviate this situation, but the costs of such programs are unknown.

Aim

To evaluate the costs of a school-based screening program for hearing disorders, among approximately 216,000 school children, and the delivery of hearing aids to 206 children at three different care levels in China.

Methods

In a prospective study design, screening and hearing aid delivery costs were estimated on the basis of program records and an empirical assessment of health personnel time input. Household costs for seeking and undergoing hearing health care were collected with a questionnaire, administered to the parents of the child. Data were collected at three study sites representing primary, secondary and tertiary care levels.

Results

Total screening and hearing aid delivery costs ranged between RMB70,000 (US$9,000) and RMB133,000 (US$17,000) in the three study sites. Health care cost per child fitted ranged from RMB5,900 (US$760) at the primary care level, RMB7,200 (US$940) at the secondary care level, to RMB8,600 (US$1,120) at the tertiary care level. Household costs were only a small fraction of the overall costs. Cost per child fitted ranged between RMB1,608 and RMB2,812 (US$209-US$365), depending on perspective of analysis and study site. The program was always least costly in the primary care setting.

Conclusion

Hearing screening and the delivery of hearing aids in China is least costly in a primary care setting. Important questions remain concerning its implementation.

SUBMITTER: Baltussen R

PROVIDER: S-EPMC2679736 | biostudies-literature | 2009 Apr

REPOSITORIES: biostudies-literature

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Publications

Costs of screening children for hearing disorders and delivery of hearing aids in China.

Baltussen Rob R Li Ju J Wu Li Dong LD Ge Xiao Hui XH Teng Bai Yu BY Sun Xi Bin XB Han Rui R Wang Xiao Li XL McPherson Bradley B

BMC health services research 20090416

<h4>Background</h4>The burden of disease of hearing disorders among children is high, but a large part goes undetected. School-based screening programs in combination with the delivery of hearing aids can alleviate this situation, but the costs of such programs are unknown.<h4>Aim</h4>To evaluate the costs of a school-based screening program for hearing disorders, among approximately 216,000 school children, and the delivery of hearing aids to 206 children at three different care levels in China ...[more]

PMID: 19371419

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Project description:BackgroundThe burden of disease of hearing disorders among adults is high, but a significant part goes undetected. Screening programs in combination with the delivery of hearing aids can alleviate this situation, but the economic attractiveness of such programs is unknown. This study aims to evaluate the population-level costs, effects and cost-effectiveness of alternative delivering hearing aids models in Tamil Nadu, IndiaMethodsIn an observational study design, we estimated total costs and effects of two active screening programs in the community in combination with the provision of hearing aids at secondary care level, and the costs and effects of the provision of hearing aids at tertiary care level. Screening and hearing aid delivery costs were estimated on the basis of program records and an empirical assessment of health personnel time input. Household costs for seeking and undergoing hearing health care were collected with a questionnaire (see Additional file 2). Health effects were estimated on the basis of compliance with the hearing aid, and associated changes in disability, and were expressed in disability-adjusted life years (DALYs) averted.ResultsActive screening and provision of hearing aids at the secondary care level costs around Rs.7,000 (US$152) per patient, whereas provision of hearing aids at the tertiary care level costs Rs 5,693 (US$122) per patient. The cost per DALY averted was around RS 42,200 (US$900) at secondary care level and Rs 33,900 (US$720) at tertiary care level. The majority of people did consult other providers before being screened in the community. Costs of food and transport ranged between Rs. 2 (US$0,04) and Rs. 39 (US$0,83).ConclusionActive screening and provision of hearing aids at the secondary care level is slightly more costly than passive screening and fitting of hearing aids at the tertiary care level, but seems also able to reach a higher coverage of hearing aids services. Although crude estimates indicate that both passive and active screening programs can be cautiously considered as cost-effective according to international thresholds, important questions remain regarding the implementation of the latter.

Project description:Purpose The classroom acoustic standard ANSI/ASA S12.60-2010/Part 1 requires a reverberation time (RT) for children with hearing impairment of 0.3 s, shorter than its requirement of 0.6 s for children with typical hearing. While preliminary data from conference proceedings support this new RT requirement of 0.3 s, peer-reviewed data that support 0.3-s RT are not available on those wearing hearing aids. To help address this, this article compares speech perception performance by children with hearing aids in RTs, including those specified in the ANSI/ASA-2010 standard. A related clinical issue is whether assessments of speech perception conducted in near-anechoic sound booths, which may overestimate performance in reverberant classrooms, may now provide a more reliable estimate when the child is in a classroom with a short RT of 0.3 s. To address this, this study compared speech perception by children with hearing aids in a sound booth to listening in 0.3-s RT. Method Participants listened in classroom RTs of 0.3, 0.6, and 0.9 s and in a near-anechoic sound booth. All conditions also included a 21-dB range of speech-to-noise ratios (SNRs) to further represent classroom listening environments. Performance measures using the Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN) test were 50% correct word recognition across these acoustic conditions, with supplementary analyses of percent correct. Results Each reduction in RT from 0.9 to 0.6 to 0.3 s significantly benefited the children's perception of speech. Scores obtained in a sound booth were significantly better than those measured in 0.3-s RT. Conclusion These results support the acoustic standard of 0.3-s RT for children with hearing impairment in learning spaces ? 283 m3, as specified in ANSI/ASA S12.60-2010/Part 1. Additionally, speech perception testing in a sound booth did not predict accurately listening ability in a classroom with 0.3-s RT. Supplemental Material https://doi.org/10.23641/asha.11356487.

Project description:IMPORTANCE Hearing loss (HL) in children can be deleterious to their speech and language development. The standard of practice has been early provision of hearing aids (HAs) to moderate these effects; however, there have been few empirical studies evaluating the effectiveness of this practice on speech and language development among children with mild-to-severe HL. OBJECTIVE To investigate the contributions of aided hearing and duration of HA use to speech and language outcomes in children with mild-to-severe HL. DESIGN, SETTING, AND PARTICIPANTS An observational cross-sectional design was used to examine the association of aided hearing levels and length of HA use with levels of speech and language outcomes. One hundred eighty 3- and 5-year-old children with HL were recruited through records of Universal Newborn Hearing Screening and referrals from clinical service providers in the general community in 6 US states. INTERVENTIONS All but 4 children had been fitted with HAs, and measures of aided hearing and the duration of HA use were obtained. MAIN OUTCOMES AND MEASURES Standardized measures of speech and language ability were obtained. RESULTS Measures of the gain in hearing ability for speech provided by the HA were significantly correlated with levels of speech (?179?=?0.20; P?=?.008) and language: ?155?=?0.21; P?=?.01) ability. These correlations were indicative of modest levels of association between aided hearing and speech and language outcomes. These benefits were found for children with mild and moderate-to-severe HL. In addition, the amount of benefit from aided hearing interacted with the duration of HA experience (Speech: F4,161?=?4.98; P?<?.001; Language: F4,138?=?2.91; P?<?.02). Longer duration of HA experience was most beneficial for children who had the best aided hearing. CONCLUSIONS AND RELEVANCE The degree of improved hearing provided by HAs was associated with better speech and language development in children. In addition, the duration of HA experience interacted with the aided hearing to influence outcomes. These results provide support for the provision of well-fitted HAs to children with HL. In particular, the findings support early HA fitting and HA provision to children with mild HL.

Project description:This article reports on the psychosocial development and factors influencing outcomes of 5-year-old children with cochlear implants (CIs) or hearing aids (HAs). It further examines differences between children with CIs and HAs with similar levels of hearing loss. Data were collected as part of the Longitudinal Outcomes of Children with Hearing Impairment study-a prospective, population-based study. Parents/caregivers of children completed the Strengths and Difficulties Questionnaire ( n = 333), the Social Skills subscale from the Child Development Inventory ( n = 317), and questionnaires on functional auditory behavior (Parents' Evaluation of Aural/oral performance of Children), and demographics. Children completed assessments of nonverbal cognitive ability (Wechsler Non-verbal Scale of Ability) and language (Preschool Language Scale - fourth edition). On average, parent-rated Strengths and Difficulties Questionnaire scores on emotional or behavioral difficulties were within 1 SD of the normative mean; however, Child Development Inventory scores on social skills were more than 1 SD below the norm. Children with severe-to-profound hearing losses using HAs had significantly more behavioral problems than children with CIs. Regression analyses showed that non-verbal cognitive ability, language, and functional auditory behavior were significantly associated with psychosocial outcomes for children with HAs, whereas outcomes for children with CIs were associated with functional auditory behavior and the presence of additional disabilities. Age at hearing intervention, severity of hearing loss, and communication mode were not associated with outcomes. The results suggest that even children who develop good language ability with the help of a HA or CI may have psychosocial problems if they exhibit difficulties with listening and communicating in everyday environments. The findings have implications for developing interventions for young children with hearing loss.

Project description:BACKGROUND:Current data suggest that approximately 466 million people (5.0%) of the world's population have disabling hearing loss, therefrom, 34 million children, impacting their quality of life. To provide estimates on the prevalence of hearing loss on a national level, we reviewed the epidemiological literature addressing hearing loss in children and adolescents living in Germany as an example for a Western country. METHODS:We searched Medline, Web of Science, Cochrane Library, ScienceDirect and LIVIVO to identify published data. Furthermore, we manually searched websites of relevant institutions and journals not listed in electronically and searched for ongoing studies and/or not yet published data in clinicaltrials.gov . Study selection, data extraction, and methodological assessment were carried out by two reviewers. RESULTS:In total, 11 reports provided data with sample sizes ranging from 310 up to more than 14 million children and adolescents. Prevalence data were collected by interviews (self-assessments), using pure-tone audiometry or the international classification of diseases (ICD-10) coding and ranged from 0.1 to 128 per 1000 children. Although the estimate of the prevalence of hearing loss goes down, when the threshold was raised, generating a comprehensive and coherent set of estimates proved challenging owing to clinical heterogeneity including variation in age, the study setting, the definition of hearing loss and the assessment method. Moreover, representativeness (external validity) was often impaired owing to estimates lacking currentness (i.e., referring to former West Germany) or selected (patient) data and may not be typical for a more general population. CONCLUSIONS:In conclusions, this work raises public awareness of the high prevalence of hearing loss, highlights issues associated with epidemiological research and is of great importance for researcher and those who use epidemiological data to inform clinical and political decision making.

Project description:PurposeTo systematically review the existing literature that examines the relationship between cognition, hearing, and language in children using cochlear implants and hearing aids.MethodThe review has been registered in Prospero (Registration: CRD 42020203974). The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and examined the scientific literature in VHL, MEDLINE, CINAHL, Scopus, WOS, and Embase. It included original observational studies in children using hearing aids and/or cochlear implants who underwent cognitive and auditory and/or language tests. Data were extracted from the studies and their level of evidence was graded with the Oxford Center for Evidence-Based Medicine: Levels of Evidence. Meta-analysis could not be performed due to data heterogeneity. Outcomes are described in narrative and tables synthesis.ResultsThe systematic search and subsequent full-text evaluation identified 21 studies, conducted in 10 different countries. Altogether, their samples comprised 1,098 individuals, aged 0.16-12.6 years. The studies assessed the following cognitive domains: memory, nonverbal cognition, reasoning, attention, executive functions, language, perceptual-motor function, visuoconstructive ability, processing speed, and phonological processing/phonological memory. Children with hearing loss using cochlear implants and hearing aids scored significantly lower in many cognitive functions than normal hearing (NH) children. Neurocognitive functions were correlated with hearing and language outcomes.ConclusionMany cognitive tools were used to assess cognitive function in children with hearing devices. Results suggest that children with cochlear implants and hearing aids have cognitive deficits; these outcomes are mainly correlated with vocabulary. This study highlights the need to understand children's cognitive function and increase the knowledge of the relationship between cognition, language, and hearing in children using cochlear implants and hearing aids.

Dataset Information

Costs of screening children for hearing disorders and delivery of hearing aids in China.

Background

Aim

Methods

Results

Conclusion

Publications

Costs of screening children for hearing disorders and delivery of hearing aids in China.

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