title: The Cost-Effectiveness of Different Hearing Screening Strategies for 50- to 70-Year-Old Adults: A Markov Model.
abstract: OBJECTIVE
  To assess the cost-effectiveness of screening 50- to 70-year-old adults for hearing loss in The Netherlands. We compared no screening, telephone screening, Internet screening, screening with a handheld screening device, and audiometric screening for various starting ages and a varying number of repeated screenings.
  
  
  METHODS
  The costs per quality-adjusted life-year (QALY) for no screening and for 76 screening strategies were analyzed using a Markov model with cohort simulation for the year 2011. Screening was deemed to be cost-effective if the costs were less than €20,000/QALY.
  
  
  RESULTS
  Screening with a handheld screening device and audiometric screening were generally more costly but less effective than telephone and Internet screening. Internet screening strategies were slightly better than telephone screening strategies. Internet screening at age 50 years, repeated at ages 55, 60, 65, and 70 years, was the most cost-effective strategy, costing €3699/QALY. At a threshold of €20,000/QALY, this strategy was with 100% certainty cost-effective compared with current practice and with 69% certainty the most cost-effective strategy among all strategies.
  
  
  CONCLUSIONS
  This study suggests that Internet screening at age 50 years, repeated at ages 55, 60, 65, and 70 years, is the optimal strategy to screen for hearing loss and might be considered for nationwide implementation.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands. Electronic address: anouk.linssen@mumc.nl.
authors: Anouk M
authors: AM
authors: Linssen
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors: Lucien J C
authors: LJ
authors: Anteunis
authors: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors: Manuela A
authors: MA
authors: Joore
mesh_terms: D000367:Age Factors; D000368:Aged; D001299:Audiometry / Q000191:economics; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006311:Hearing Disorders / Q000175:diagnosis* / Q000191:economics*; D006320:Hearing Tests / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D020407:Internet / Q000191:economics; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009426:Netherlands; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D013689:Telephone / Q000191:economics
keywords: Markov model; adults; cost-effectiveness; hearing loss; screening