title: An economic evaluation of screening 60- to 70-year-old adults for hearing loss.
abstract: BACKGROUND
  Hearing loss is common among older adults and has consequences for sufferers, families and society, but there is substantial unmet need for intervention. Screening could expedite intervention and improve outcomes.
  
  
  METHODS
  We use Markov models to estimate the incremental cost-effectiveness ratio (ICER) of potential screening programmes compared with current provision (GP-referral), from a health service perspective. Alternative options are investigated through scenario analysis. One-way and probabilistic sensitivity analyses are undertaken.
  
  
  RESULTS
  All modelled screens are cost-effective and reduce unmet need for hearing aids. The most cost-effective option identified is a one-stage audiometric screen for bilateral hearing loss ≥30 dB hearing level (HL) at age 60, repeated at ages 65 and 70. This option has an ICER of £1461 compared to GP-referral and would mean an additional 15 437 adults benefiting from hearing intervention per 100 000 population aged 60. The cost-effectiveness acceptability curve shows that screening is more cost-effective than GP-referral provided a Quality Adjusted Life Year is valued at £2000 or more.
  
  
  CONCLUSIONS
  Adult hearing screening would provide a cost-effective way to improve quality of life for older adults. We recommend piloting an audiometric screen offered to all adults age 60, 65 and 70 years to identify bilateral hearing loss of at least 30 dB HL.
authors.affiliation: School of Public Health, Wessex Deanery, Winchester SO21 2RU, UK. annamorris2@nhs.net
authors.forename: A E
authors.initials: AE
authors.lastname: Morris
authors.forename: M E
authors.initials: ME
authors.lastname: Lutman
authors.forename: A J
authors.initials: AJ
authors.lastname: Cook
authors.forename: D
authors.initials: D
authors.lastname: Turner
mesh_terms: D000368:Aged; D001299:Audiometry / Q000191:economics; D003362:Cost-Benefit Analysis; D006312:Hearing Loss, Bilateral / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation / Q000191:economics; D012680:Sensitivity and Specificity