Economic Evaluation and Research Prioritization of Adult Hearing Screening in the US

项目摘要/摘要 超过70%的美国成年人在一生中的某个时候会受到听力损失的影响，并对 患者的生活质量和整体健康状况。对轻中度听力损失的有效治疗包括听力 助听器提供，但超过80%的成年人听力损失不使用助听器。造成这一现象的一个因素是 治疗差距是缺乏听力损失意识，对听力筛查没有统一的指导 成年人。目前美国成年人听力筛查的指导方针是相互矛盾的，美国的总体筛查率 美国的发病率较低，尽管有可能及早发现并与有益的医疗保健联系起来。 缺乏统一的指导方针的部分原因是缺乏足够的量化证据来证明长期的- 美国成人听力筛查策略的长期临床和经济效果。拟议的研究 寻求解决这一证据差距，并有帮助美国临床和政策的长期目标 决策者确定最有效和最具成本效益的成人听力筛查计划 人口。目的1开发并验证成人听力筛查的决策建模框架， 在美国的诊断和治疗。这些建模工作与正在进行的柳叶刀联合进行 听力损失委员会将提供临床和政策专家指导和支持。AIM 2将利用 从目标1到预测替代成人听力的临床和经济影响的建模框架 在美国放映节目。该分析将预测不同筛查干预措施的成本和收益 按首次筛查年龄、筛查频率和筛查测试方式。目标3将估计经济 从减少模型输入的不确定性中获益，这可以通过未来的研究来实现。 这一目的将通过信息分析的价值为未来成人听力筛查研究提供优先顺序。 这三个目标的结果将阐明针对成人听力的研究的最佳政策和投资 在美国放映。 此奖学金申请旨在为PI做好准备，以实现他成为 独立内科科学家使用决策科学增加老年护理的价值和提供 人口。为了实现这一长期目标，他将发展决策科学和 人口健康科学，最大限度地提高他的研究的政策相关性，获得进一步的临床经验和 将临床知识融入到他的研究中，并培养成功职业生涯的关键专业技能。这个 拟议的严格临床和研究培训将使PI能够为他未来的职业生涯做好准备 临床医生调查员。

PROJECT SUMMARY/ABSTRACT Hearing loss affects over 70% of US adults at some point in their lifetime and has significant effects on patient quality of life and overall health. Effective treatment for mild to moderate hearing loss includes hearing aid provision, but over 80% of adults with hearing loss do not use a hearing aid. One factor contributing to this treatment gap is lack of awareness of hearing loss and no uniform guidance around hearing screening in adults. Current guidelines on US adult hearing screening are conflicting, and overall rates of screening in the US are low despite the potential for early detection and linkage to beneficial care. This lack of uniform guidelines is in part due to the absence of sufficient quantitative evidence on the long- term clinical and economic effects of adult hearing screening strategies in the US. The proposed research seeks to address this evidence gap and has the long-term goal of helping US clinical and policy decisionmakers identify the most effective and cost-effective adult hearing screening programs for their populations. Aim 1 develops and validates a decision modeling framework of adult hearing screening, diagnosis, and treatment in the US. These modeling efforts are in conjunction with an ongoing Lancet Commission on Hearing Loss that will provide clinical and policy expert guidance and support. Aim 2 will utilize the modeling framework from Aim 1 to project clinical and economic effects of alternative adult hearing screening programs in the US. The analysis will project costs and benefits of screening interventions that vary by age at first screen, screening frequency, and screening test modality. Aim 3 will estimate the economic benefit obtained from reductions in uncertainty of model inputs that can be achieved through future research. This Aim will inform future adult hearing screening research prioritization through value of information analysis. The results of these three Aims will clarify optimal policy and investment in research targeting adult hearing screening in the US. This fellowship application is designed to prepare the PI to achieve his long-term goal of becoming an independent physician scientist using decision science to increase the value and provision of care for aging populations. Towards that long-term goal he will develop skills in advanced methods in decision science and population health sciences, maximize the policy relevance of his research, gain further clinical experiences and integrate clinical knowledge into his research, and build professional skills key to a successful career. The rigorous clinical and research training proposed will enable the PI to be well-positioned for his future career as a clinician investigator.