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Published in: BMC Pediatrics 1/2022

01-12-2022 | Research

Cost-effectiveness analysis of hearing screening program for primary school children in southern Iran, Shiraz

Authors: Mohammad Faramarzi, Sara Babakhani fard, Mohsen Bayati, Fatemeh Jafarlou, Mohammadreza Parhizgar, Mehdi Rezaee, Khosro Keshavarz

Published in: BMC Pediatrics | Issue 1/2022

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Abstract

Background

Hearing loss is the second most common chronic disease, the diagnosis and treatment of which can be faster through screening. In addition, early interventions will save significant costs for the education and health systems. Therefore, the present study aimed to evaluate the cost-effectiveness of hearing screening for primary school children in Shiraz.

Methods

This cross-sectional economic evaluation of cost-effectiveness was conducted from the perspective of the health system. The study population comprised all seven-year-old children participating in the screening program in Shiraz. The present study dealt only with direct costs. The expected costs and outcomes, as well as the ICER index were estimated using the decision tree model. The study outcomes included averted disability-adjusted life years (DALY) and true identification of hearing loss cases. The robustness of the results was evaluated using the one-way sensitivity analysis. The TreeAge 2020 and Excel 2016 software were also used to analyze the collected data.

Results

The hearing screening data obtained during 6 years (2015–2020) showed that every year, an average of 22,853 children in Shiraz were examined for hearing, of which 260 were true positive (%1.1). The costs of screening and lack of screening were estimated at $30.32 Purchasing Power Parity (PPP) and $13.75 PPP per child, respectively. The averted DALY due to performing hearing screening was estimated at 7 years for each child. The ICER was positive and equal to $ 0.06 PPP for the identified cases and $ 2.37 PPP per averted DALY. The sensitivity analysis confirmed the robustness of the results.

Conclusions

According to the results, although hearing screening for primary school children had more costs and effectiveness, it was considered cost-effective. Therefore, universal screening with high quality and accuracy is recommended.
Literature
1.
go back to reference Lipton R, Schwedt T, Friedman B, GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2017;388(10053):1545–602. Lipton R, Schwedt T, Friedman B, GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2017;388(10053):1545–602.
2.
go back to reference Chojecki D, Harstall C, Yan C, Chuck AA, Corabian P. The safety and efficacy/effectiveness of using automated testing devices for universal newborn hearing screening: an Update; 2012. Chojecki D, Harstall C, Yan C, Chuck AA, Corabian P. The safety and efficacy/effectiveness of using automated testing devices for universal newborn hearing screening: an Update; 2012.
3.
go back to reference Schnell-Inderst P, Kunze S, Hessel F, Grill E, Nickisch A, Siebert U, et al. Hörscreening für Neugeborene-Health Technology Assessment der medizinischen Effektivität und ökonomischen Effizienz. 5 Symposium Health Technology Assessment Screening und Prävention–Nutzen, Kosten, Wirksamkeit 11 bis 12 November 2004 Köln. Schnell-Inderst P, Kunze S, Hessel F, Grill E, Nickisch A, Siebert U, et al. Hörscreening für Neugeborene-Health Technology Assessment der medizinischen Effektivität und ökonomischen Effizienz. 5 Symposium Health Technology Assessment Screening und Prävention–Nutzen, Kosten, Wirksamkeit 11 bis 12 November 2004 Köln.
4.
go back to reference Farhadi M, Mahmoudian S, Mohammad K, Daneshi A. The pilot study of a nationwide neonatal hearing screening in Iran: Akbarabadi and Mirzakouchak-khan hospitals in Tehran (June 2003–October 2004); 2006. Farhadi M, Mahmoudian S, Mohammad K, Daneshi A. The pilot study of a nationwide neonatal hearing screening in Iran: Akbarabadi and Mirzakouchak-khan hospitals in Tehran (June 2003–October 2004); 2006.
5.
go back to reference Torkaman M, Amirsalari S, Firouzabadi M, Afsharpayman S, Kavehmanesh Z, Beiraghdar F, et al. Evaluation of universal newborn hearing screening with transient-evoked otoacoustic emission and auditory brainstem response: a cross-sectional study with the literature review. J Isfahan Med School. 2012;30(201):1199-207. Torkaman M, Amirsalari S, Firouzabadi M, Afsharpayman S, Kavehmanesh Z, Beiraghdar F, et al. Evaluation of universal newborn hearing screening with transient-evoked otoacoustic emission and auditory brainstem response: a cross-sectional study with the literature review. J Isfahan Med School. 2012;30(201):1199-207.
6.
go back to reference Markides A. Shortpaper: age at fitting of hearing aids and speech intelligibility. Br J Audiol. 1986;20(2):165–7.CrossRef Markides A. Shortpaper: age at fitting of hearing aids and speech intelligibility. Br J Audiol. 1986;20(2):165–7.CrossRef
7.
go back to reference Mehl AL, Thomson V. Newborn hearing screening: the great omission. Pediatrics. 1998;101(1):e4-e.CrossRef Mehl AL, Thomson V. Newborn hearing screening: the great omission. Pediatrics. 1998;101(1):e4-e.CrossRef
8.
go back to reference Gantt S, Dionne F, Kozak FK, Goshen O, Goldfarb DM, Park AH, et al. Cost-effectiveness of universal and targeted newborn screening for congenital cytomegalovirus infection. JAMA Pediatr. 2016;170(12):1173–80.CrossRef Gantt S, Dionne F, Kozak FK, Goshen O, Goldfarb DM, Park AH, et al. Cost-effectiveness of universal and targeted newborn screening for congenital cytomegalovirus infection. JAMA Pediatr. 2016;170(12):1173–80.CrossRef
9.
go back to reference Walger M. Hörstörungen und Hörbahnreifung-Über die Bedeutung der Früherkennung und Therapie kindlicher Hörstörungen. Hörbericht. 2000;67:1–7. Walger M. Hörstörungen und Hörbahnreifung-Über die Bedeutung der Früherkennung und Therapie kindlicher Hörstörungen. Hörbericht. 2000;67:1–7.
10.
go back to reference Yoshinaga-Itano C, Apuzzo M-rL. The development of deaf and hard of hearing children identified early through the high-risk registry. Am Ann Deaf. 1998:416–24. Yoshinaga-Itano C, Apuzzo M-rL. The development of deaf and hard of hearing children identified early through the high-risk registry. Am Ann Deaf. 1998:416–24.
11.
go back to reference Hessel F, Grill E, Schnell-Inderst P, Siebert U, Kunze S, Nickisch A, et al. Economic evaluation of newborn hearing screening: modelling costs and outcomes. Ger Med Sci. 2003:1, Doc09. Hessel F, Grill E, Schnell-Inderst P, Siebert U, Kunze S, Nickisch A, et al. Economic evaluation of newborn hearing screening: modelling costs and outcomes. Ger Med Sci. 2003:1, Doc09.
12.
go back to reference Molini E, Ricci G, Baroni S, Ciorba A, Bellocci A, Simoncelli C. Identifying congenital hearing impairment. Personal experience based on selective hearing screening. Acta Otorhinolaryngol Ital. 2004;24:109–16.PubMed Molini E, Ricci G, Baroni S, Ciorba A, Bellocci A, Simoncelli C. Identifying congenital hearing impairment. Personal experience based on selective hearing screening. Acta Otorhinolaryngol Ital. 2004;24:109–16.PubMed
13.
go back to reference Mauk GW, Behrens TR. Historical, political, and technological context associated with early identification of hearing loss: Seminars in Hearing; 1993. Mauk GW, Behrens TR. Historical, political, and technological context associated with early identification of hearing loss: Seminars in Hearing; 1993.
14.
go back to reference Hearing JCoI, Pediatrics AAo, Association AS-L-H. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2000;106(4):798–817.CrossRef Hearing JCoI, Pediatrics AAo, Association AS-L-H. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2000;106(4):798–817.CrossRef
15.
go back to reference Burke MJ, Shenton RC, Taylor MJ. The economics of screening infants at risk of hearing impairment: an international analysis. Int J Pediatr Otorhinolaryngol. 2012;76(2):212–8.CrossRef Burke MJ, Shenton RC, Taylor MJ. The economics of screening infants at risk of hearing impairment: an international analysis. Int J Pediatr Otorhinolaryngol. 2012;76(2):212–8.CrossRef
16.
go back to reference Firouzbakht M, Eftekhar AH, Majlesi F, Rahimi FA, Ansari DM, Esmaeilzadeh M. Prevalence of neonatal hearing impairment in province capitals; 2008. Firouzbakht M, Eftekhar AH, Majlesi F, Rahimi FA, Ansari DM, Esmaeilzadeh M. Prevalence of neonatal hearing impairment in province capitals; 2008.
17.
go back to reference Olusanya B, Luxon L, Wirz S. Benefits and challenges of newborn hearing screening for developing countries. Int J Pediatr Otorhinolaryngol. 2004;68(3):287–305.CrossRef Olusanya B, Luxon L, Wirz S. Benefits and challenges of newborn hearing screening for developing countries. Int J Pediatr Otorhinolaryngol. 2004;68(3):287–305.CrossRef
18.
go back to reference Ching TY. Is early intervention effective in improving spoken language outcomes of children with congenital hearing loss? Am J Audiol. 2015;24(3):345–8.CrossRef Ching TY. Is early intervention effective in improving spoken language outcomes of children with congenital hearing loss? Am J Audiol. 2015;24(3):345–8.CrossRef
19.
go back to reference Ciorba A, Hatzopoulos S, Busi M, Guerrini P, Petruccelli J, Martini A. The universal newborn hearing screening program at the University Hospital of Ferrara: focus on costs and software solutions. Int J Pediatr Otorhinolaryngol. 2008;72(6):807–16.CrossRef Ciorba A, Hatzopoulos S, Busi M, Guerrini P, Petruccelli J, Martini A. The universal newborn hearing screening program at the University Hospital of Ferrara: focus on costs and software solutions. Int J Pediatr Otorhinolaryngol. 2008;72(6):807–16.CrossRef
20.
go back to reference Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child. 2010;95(2):130–5.CrossRef Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child. 2010;95(2):130–5.CrossRef
21.
go back to reference Fortnum H, Ukoumunne OC, Hyde C, Taylor RS, Ozolins M, Errington S, et al. A programme of studies including assessment of diagnostic accuracy of school hearing screening tests and a cost-effectiveness model of school entry hearing screening programmes. Health Technol Assess. 2016;20(36):1–178.CrossRef Fortnum H, Ukoumunne OC, Hyde C, Taylor RS, Ozolins M, Errington S, et al. A programme of studies including assessment of diagnostic accuracy of school hearing screening tests and a cost-effectiveness model of school entry hearing screening programmes. Health Technol Assess. 2016;20(36):1–178.CrossRef
22.
go back to reference Organization WH. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report, 2017: World Health Organization; 2017. Organization WH. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report, 2017: World Health Organization; 2017.
23.
go back to reference Keren R, Helfand M, Homer C, McPhillips H, Lieu TA. Projected cost-effectiveness of statewide universal newborn hearing screening. Pediatrics. 2002;110(5):855–64.CrossRef Keren R, Helfand M, Homer C, McPhillips H, Lieu TA. Projected cost-effectiveness of statewide universal newborn hearing screening. Pediatrics. 2002;110(5):855–64.CrossRef
24.
go back to reference Sarafraz M, HEKMAT SM, Zaheri S. Determination of hearing loss prevalence in preschool children of Ahwaz; 2011. Sarafraz M, HEKMAT SM, Zaheri S. Determination of hearing loss prevalence in preschool children of Ahwaz; 2011.
25.
go back to reference Erenberg A, Lemons J, Sia C, Trunkel D, Ziring P. Newborn and infant hearing loss: detection and intervention. American Academy of Pediatrics. Task force on newborn and infant hearing, 1998-1999. Pediatrics. 1999;103(2):527–30.CrossRef Erenberg A, Lemons J, Sia C, Trunkel D, Ziring P. Newborn and infant hearing loss: detection and intervention. American Academy of Pediatrics. Task force on newborn and infant hearing, 1998-1999. Pediatrics. 1999;103(2):527–30.CrossRef
26.
go back to reference Kezirian EJ, White KR, Yueh B, Sullivan SD. Cost and cost-effectiveness of universal screening for hearing loss in newborns. Otolaryngol Head Neck Surg. 2001;124(4):359–67.CrossRef Kezirian EJ, White KR, Yueh B, Sullivan SD. Cost and cost-effectiveness of universal screening for hearing loss in newborns. Otolaryngol Head Neck Surg. 2001;124(4):359–67.CrossRef
27.
go back to reference Colgan S, Gold L, Wirth K, Ching T, Poulakis Z, Rickards F, et al. The cost-effectiveness of universal newborn screening for bilateral permanent congenital hearing impairment: systematic review. Acad Pediatr. 2012;12(3):171–80.CrossRef Colgan S, Gold L, Wirth K, Ching T, Poulakis Z, Rickards F, et al. The cost-effectiveness of universal newborn screening for bilateral permanent congenital hearing impairment: systematic review. Acad Pediatr. 2012;12(3):171–80.CrossRef
28.
go back to reference Devleesschauwer B, Havelaar AH, De Noordhout CM, Haagsma JA, Praet N, Dorny P, et al. DALY calculation in practice: a stepwise approach. Int J Public Health. 2014;59(3):571–4.CrossRef Devleesschauwer B, Havelaar AH, De Noordhout CM, Haagsma JA, Praet N, Dorny P, et al. DALY calculation in practice: a stepwise approach. Int J Public Health. 2014;59(3):571–4.CrossRef
29.
go back to reference Orji A, Kamenov K, Dirac M, Davis A, Chadha S, Vos T. Global and regional needs, unmet needs and access to hearing aids. Int J Audiol. 2020;59(3):166–72.CrossRef Orji A, Kamenov K, Dirac M, Davis A, Chadha S, Vos T. Global and regional needs, unmet needs and access to hearing aids. Int J Audiol. 2020;59(3):166–72.CrossRef
31.
go back to reference Rezapour A, Jafari A, Mirmasoudi K, Talebianpour H. Quality assessment of published articles in Iranian journals related to economic evaluation in health care programs based on Drummond’s checklist: a narrative review. Iranian J Med Sci. 2017;42(5):427. Rezapour A, Jafari A, Mirmasoudi K, Talebianpour H. Quality assessment of published articles in Iranian journals related to economic evaluation in health care programs based on Drummond’s checklist: a narrative review. Iranian J Med Sci. 2017;42(5):427.
32.
go back to reference Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost–effectiveness of interventions: alternative approaches. Bull World Health Organ. 2014;93:118–24.CrossRef Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost–effectiveness of interventions: alternative approaches. Bull World Health Organ. 2014;93:118–24.CrossRef
34.
go back to reference Organization WH. The global burden of disease: 2004 update: World Health Organization; 2008. Organization WH. The global burden of disease: 2004 update: World Health Organization; 2008.
35.
go back to reference Yong M, Liang J, Ballreich J, Lea J, Westerberg BD, Emmett SD. Cost-effectiveness of school hearing screening programs: a scoping review. Otolaryngol Head Neck Surg. 2020;162(6):826–38.CrossRef Yong M, Liang J, Ballreich J, Lea J, Westerberg BD, Emmett SD. Cost-effectiveness of school hearing screening programs: a scoping review. Otolaryngol Head Neck Surg. 2020;162(6):826–38.CrossRef
36.
go back to reference Yin L, Bottrell C, Clarke N, Shacks J, Poulsen MK. Otoacoustic emissions: a valid, efficient first-line hearing screen for preschool children. J Sch Health. 2009;79(4):147–52.CrossRef Yin L, Bottrell C, Clarke N, Shacks J, Poulsen MK. Otoacoustic emissions: a valid, efficient first-line hearing screen for preschool children. J Sch Health. 2009;79(4):147–52.CrossRef
37.
go back to reference Baltussen R, Smith A. Cost effectiveness of strategies to combat vision and hearing loss in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344. Baltussen R, Smith A. Cost effectiveness of strategies to combat vision and hearing loss in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344.
38.
go back to reference Aasham T, Khabori M, Helmi S. Cost-effectiveness of audiometric screening of first-year preparatory pupils in Dhofar region, Oman. EMHJ-East Mediterr Health J. 2004;10(3):303–8.CrossRef Aasham T, Khabori M, Helmi S. Cost-effectiveness of audiometric screening of first-year preparatory pupils in Dhofar region, Oman. EMHJ-East Mediterr Health J. 2004;10(3):303–8.CrossRef
39.
go back to reference Nguyen K-H, Smith AC, Armfield NR, Bensink M, Scuffham PA. Cost-effectiveness analysis of a mobile ear screening and surveillance service versus an outreach screening, surveillance and surgical service for indigenous children in Australia. PLoS One. 2015;10(9):e0138369.CrossRef Nguyen K-H, Smith AC, Armfield NR, Bensink M, Scuffham PA. Cost-effectiveness analysis of a mobile ear screening and surveillance service versus an outreach screening, surveillance and surgical service for indigenous children in Australia. PLoS One. 2015;10(9):e0138369.CrossRef
40.
go back to reference Hyde C, Fortnum H, Ukoumunne O, Ozlin M, Zhelev Z, Long L. P107 evaluation of school entry hearing screening: findings of an NIHR funded project: BMJ Publishing Group Ltd; 2016. Hyde C, Fortnum H, Ukoumunne O, Ozlin M, Zhelev Z, Long L. P107 evaluation of school entry hearing screening: findings of an NIHR funded project: BMJ Publishing Group Ltd; 2016.
41.
go back to reference Bamford J, Fortnum H, Bristow K, Smith J, Vamvakas G, Davies L, et al. Current practice, accuracy, effectiveness and cost-effectiveness of the school entry hearing screen. Health Technol Assess. 2007;11(32):1–168.CrossRefPubMed Bamford J, Fortnum H, Bristow K, Smith J, Vamvakas G, Davies L, et al. Current practice, accuracy, effectiveness and cost-effectiveness of the school entry hearing screen. Health Technol Assess. 2007;11(32):1–168.CrossRefPubMed
42.
go back to reference Rai N, Thakur N. Universal screening of newborns to detect hearing impairment—is it necessary? Int J Pediatr Otorhinolaryngol. 2013;77(6):1036–41.CrossRef Rai N, Thakur N. Universal screening of newborns to detect hearing impairment—is it necessary? Int J Pediatr Otorhinolaryngol. 2013;77(6):1036–41.CrossRef
43.
go back to reference Diener ML, Zick CD, McVicar SB, Boettger J, Park AH. Outcomes from a hearing-targeted cytomegalovirus screening program. Pediatrics. 2017;139(2):e20160789.CrossRef Diener ML, Zick CD, McVicar SB, Boettger J, Park AH. Outcomes from a hearing-targeted cytomegalovirus screening program. Pediatrics. 2017;139(2):e20160789.CrossRef
44.
go back to reference Russ S, Rickards F, Poulakis Z, Barker M, Saunders K, Wake M. Six year effectiveness of a population based two tier infant hearing screening programme. Arch Dis Child. 2002;86(4):245–50.CrossRef Russ S, Rickards F, Poulakis Z, Barker M, Saunders K, Wake M. Six year effectiveness of a population based two tier infant hearing screening programme. Arch Dis Child. 2002;86(4):245–50.CrossRef
45.
go back to reference Newton VE, Macharia I, Mugwe P, Ototo B, Kan S. Evaluation of the use of a questionnaire to detect hearing loss in Kenyan pre-school children. Int J Pediatr Otorhinolaryngol. 2001;57(3):229–34.CrossRef Newton VE, Macharia I, Mugwe P, Ototo B, Kan S. Evaluation of the use of a questionnaire to detect hearing loss in Kenyan pre-school children. Int J Pediatr Otorhinolaryngol. 2001;57(3):229–34.CrossRef
46.
go back to reference Bush ML, Taylor ZR, Noblitt B, Shackleford T, Gal TJ, Shinn JB, et al. Promotion of early pediatric hearing detection through patient navigation: a randomized controlled clinical trial. Laryngoscope. 2017;127:S1–S13.CrossRef Bush ML, Taylor ZR, Noblitt B, Shackleford T, Gal TJ, Shinn JB, et al. Promotion of early pediatric hearing detection through patient navigation: a randomized controlled clinical trial. Laryngoscope. 2017;127:S1–S13.CrossRef
Metadata
Title
Cost-effectiveness analysis of hearing screening program for primary school children in southern Iran, Shiraz
Authors
Mohammad Faramarzi
Sara Babakhani fard
Mohsen Bayati
Fatemeh Jafarlou
Mohammadreza Parhizgar
Mehdi Rezaee
Khosro Keshavarz
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2022
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-022-03384-1

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