title: An evaluation of the quality of evidence available to inform current bone conducting hearing device national policy.
abstract: OBJECTIVE
  In 2016, NHS England published the commissioning policy on Bone Conducting Hearing Devices (BCHDs). This policy was informed by updated evidence on the clinical and cost-effectiveness of BCHDs as well as by the 2013 Bone Anchored Hearing Aid (BAHA) policy. Commissioning policies set the criteria for service delivery and therefore have a major impact on the care received by patients. It is important that stakeholders have a good appreciation of the available evidence informing policy, as this will promote engagement both with the policy and with future research leading on from the policy. In this article, we provide stakeholders with a transparent and pragmatic assessment of the quality of the body of evidence available to inform current BCHD national policy.
  
  
  METHODS
  (i) A systematic review of the literature on BCHDs published since the development of the 2013 policy was performed in September 2016, adhering to PRISMA recommendations. The search terms used were as follows bone conduction; bone conducting; bone anchor; BAHA; Bone Anchored Hearing Aid; Bone Conducting Hearing Device; BCHD; Bone Conducting Hearing Implant; BCHI; Sophono; Bonebridge; Soundbite; Ponto; Hearing aid; implant; device; hearing device. Publications that could inform current BCHD policy were included. The quality of included articles was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. (ii) The quality of evidence referenced by the 2013 BAHA policy was assessed using the GRADE system.
  
  
  RESULTS
  (i) Of the 2576 publications on BCHDs identified by the systematic search, 39 met the inclusion criteria for further analysis. Using the GRADE criteria, the quality of evidence was classified as of 'very low quality'. (ii) The 2013 BAHA policy was informed by 14 references. The GRADE system classifies the quality of evidence that informed the policy as of 'very low quality'.
  
  
  CONCLUSIONS
  The GRADE system defines the body of evidence available to inform current national BCHD policy as of 'very low quality'. There is an urgent need for high-quality research to help make informed policy decisions about the care of patients with hearing loss. An (inter)national registry of BCHDs could address this need.
authors.affiliation: evidENT, Ear Institute, University College London, London, UK.
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-5839-2735
authors.initials: R
authors.lastname: Mandavia
authors.affiliation: Centre for Health Policy, Imperial College London, London, UK.
authors.forename: A W
authors.initials: AW
authors.lastname: Carter
authors.affiliation: Wound Healing Research Group, Royal Free Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Haram
authors.affiliation: Centre for Health Policy, Imperial College London, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Mossialos
authors.affiliation: evidENT, Ear Institute, University College London, London, UK.
authors.forename: A G M
authors.initials: AGM
authors.lastname: Schilder
mesh_terms: D001844:Bone Conduction; D004739:England; D006291:Health Policy; D006310:Hearing Aids; D006314:Hearing Loss, Conductive / Q000534:rehabilitation*; D006801:Humans