Economic Evaluations of Childhood Hearing Loss Screening Programmes: A Systematic Review and Critique

  • Rajan SharmaEmail author
  • Yuanyuan Gu
  • Theresa Y. C. Ching
  • Vivienne Marnane
  • Bonny Parkinson
Systematic Review



Permanent childhood hearing loss is one of the most common birth conditions associated with speech and language delay. A hearing screening can result in early detection and intervention for hearing loss.


To update and expand previous systematic reviews of economic evaluations of childhood hearing screening strategies, and explore the methodological differences.

Data Sources

MEDLINE, Embase, the Cochrane database, National Health Services Economic Evaluation Database (NHS EED), the Health Technology Assessment (HTA) database, and Canadian Agency for Drugs and Technologies in Health’s (CADTH) Grey matters.

Study Eligibility Criteria, Participants and Interventions

Economic evaluations reporting costs and outcomes for both the intervention and comparator arms related to childhood hearing screening strategies.


Thirty evaluations (from 29 articles) were included for review. Several methodological issues were identified, including: few evaluations reported outcomes in terms of quality-adjusted life years (QALYs); none estimated utilities directly from surveying children; none included disutilities and costs associated with adverse events; few included costs and outcomes that differed by severity; few included long-term estimates; none considered acquired hearing loss; some did not present incremental results; and few conducted comprehensive univariate or probabilistic sensitivity analysis. Evaluations published post-2011 were more likely to report QALYs and disability-adjusted life years (DALYs) as outcome measures, include long-term treatment and productivity costs, and present incremental results.


We were unable to access the economic models and, although we employed an extensive search strategy, potentially not all relevant economic evaluations were identified.

Conclusions and Implications

Most economic evaluations concluded that childhood hearing screening is value for money. However, there were significant methodological limitations with the evaluations.



RS, YG, and BP designed the systematic review. RS and BP applied the selection criteria to the identified studies. RS extracted and synthesised the data with input from BP. RS drafted the manuscript, with input from YG, TYCC, VM and BP. RS acts as guarantor for the paper and accepts full responsibility for the conduct of the review and decision to publish.

Compliance with Ethical standards


This study was a part of a Ph.D. project funded by International Macquarie University Research Excellence Scholarship (iMQRES). This work was also partially supported by the National Institute on Deafness and Other Communication Disorders (Grant no. R01DC008080) awarded to TYCC, and by the Commonwealth of Australia through the Office of Hearing Services and the HEARing CRC.

Conflict of interest

The authors (RS, YG, TYCC, VM, and BP) declare that they have no financial or non-financial conflict of interest in the subject matter or materials discussed in this manuscript.

Supplementary material

40258_2018_456_MOESM1_ESM.docx (122 kb)
Supplementary material 1 (DOCX 122 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Macquarie University Centre for the Health EconomySydneyAustralia
  2. 2.Department of Economics and Related StudiesUniversity of YorkYorkUK
  3. 3.National Acoustic LaboratoriesAustralian Hearing HubSydneyAustralia

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