Evaluation of the School Entry Hearing Screen: addressing diagnostic accuracy and cost-effectiveness

Transcription

1 Evaluation of the School Entry Hearing Screen: addressing diagnostic accuracy and cost-effectiveness NIHR Nottingham Hearing Biomedical Research Unit Claire Benton Nottingham Audiology Services

2 Background Initial HTA project in 2007 Concluded that there was insufficient, good quality data on which to base a decision about value of school entry screen (SES) Studies comparing different screening methods have proved inconclusive and none addressed cost-effectiveness No up to date study on comparing screening to no screening Bamford J, Fortnum H, Bristow K et al. Current Practice, accuracy, effectiveness and cost effectiveness of the school entry hearing screen. Health Technol Assess 2007; 11(32)

3 Aims To determine and compare the diagnostic accuracy of two methods of screening Develop economic model: comparing yield of system with no School Entry Screen (SES) to yield, consequences and costs of system with SES

4 Project design Consists of 5 studies S1: Diagnostic accuracy of 2 screening tests S2: Collection of referral data in an area with no school hearing screen (Cambridge) S3: Collection of referral data in an area with a school hearing screen (Nottingham) Questionnaire to parents of school hearing screen referrals impact & cost of referral S4: Resources for implementation of two screens in schools S5: Economic model including data from studies 1-4 above

5 S1: Diagnostic accuracy Comparing Pure tone sweep at 20 dbhl (0.5, 1, 2 & 4 khz) HearCheck screen 55, 35, 20 1kHz 75, 55, 35 3kHz With full PTA as reference standard

6 S1: Diagnostic accuracy Participants Cases (n = 53) Sensorineural or permanent conductive hearing loss bilaterally (average 20-60dBHL) OR unilaterally (any level 20 dbhl) Age 4-6 years old Controls (n = 192) Age 4-6 years old

7 S1: Diagnostic accuracy Sensitivity/Specificity Interim analysis Sensitivity Specificity Pure tone Sweep 92.7% 82.6% HearCheck 87.9% 88.2%

8 S1: Accuracy of tests Sensitivity % 80 Specificity % PTS HC 70 PTS HC Interim analysis

9 S2&3: Outcomes with/out SES Cambridge: Secondary care clinics in community No school screen since 1997 Population Nottingham: Secondary & tertiary clinics, hospital based Had school screen in City/County Population 42553

10 S2&3: Outcomes with/out SES Collecting data for all children between 3y 0m and 6y 11m at referral Between Sept 2012 and June 2014

11 S2&3: Outcomes with/out SES Data Referral source Age at referral Band of staff in appointment Length of appointment Hearing levels Middle ear status Outcome of each appointment Questionnaire to all families referred from SES

12 S2&3: Outcomes with/out SES Cambridge No. of referrals Mean age at referral Main source of referral Referrals discharged with normal hearing Age at referral for confirmed cases No. of referrals per 1000 children per year Yield per 1000 children per year GP (40%) HV (25%) SLT (25%) 65% 48% Nottingham HV (23%) School screen (20%) Parent (14%) Interim analysis

13 S3: Outcomes with SES Parental Questionnaire data 72% required 1 or 2 appointments only 83% strongly agree children should have hearing checked at school Appointments caused moderate levels of anxiety in parents 44% parents needed to take time off work 76% children needed time out of school

14 S4&5 Resources and Economic model Data still being analysed School nurses were timed administering both PTS and HC no particular difference, but wider variation in PTS timings

15 Next steps Full analysis of all data Economic model completed Full HTA report published mid 2015

16 The Project Team University of Nottingham: Heather Fortnum, Sam Catterick, Mara Ozolins University of Exeter: Rod Taylor, Chris Hyde, Obi Ukoumunne, Vasilis Nikolaou Nottingham University Hospitals NHS Trust: Claire Benton Cambridgeshire Community Services NHS Trust: Jo Moody University of Plymouth CTU: Laura Cocking Parent representative: Jules Watson Nottinghamshire Healthcare NHS Trust: Ann Allardice & Mary Barks This project was funded by the National Institute for Health Research Health Technology Assessment Programme (project number 10/63/03) The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health.