Original Title: Efectividad, seguridad y evaluación económica de las diferentes alternativas existentes en la detección precoz de la hipoacusia en la edad pediátrica

Authors' objectives: The aim of this review is to assess the available information related to the efficiency, effectiveness and safety of the screening for hearing impairment in the paediatric population.

Authors' results and conclusions: The studies focus on universal newborn hearing screening (UNHS). For the first research question (effectiveness), a total of 924 studies were retrieved, of which 4 systematic reviews and 3 original studies were finally included. No randomized control trials about the effectiveness and safety of UNHS in terms of morbidity reduction were identified. The studies included in the systematic reviews, most of them of low quality, found that UNHS and early confirmation of permanent childhood hearing screening leads to beneficial effects on language development. However, the effect sizes were low to moderate. A good-quality cohort study only reached statistical significance for receptive language and not for expressive language or speech. Results may have been limited by the effects of initiating a new clinical service. A good-quality nonrandomized trial of a large birth cohort included in a systematic review indicates that infants identified with hearing loss through universal newborn screening have earlier referral, diagnosis, and treatment than those not screened. The reviews show that adverse effects of screening include worry, questioning, and distress that resolve for most parents. A fair quality study of a large birth cohort found that, compared with the distraction test, UNHS was associated with better developmental outcomes and quality of life among children with Permanent Childhood Hearing Impairment (PCHI). For the second research question (efficiency), a total of 140 studies were retrieved of which, 22 economic evaluations were finally included. Nine studies of cost-effectiveness of universal newborn hearing screening were identified. The following screening methods were assessed: otoacoustic emissions (OEA, acronym in Spanish, 7 studies), auditory brainstem responses (PEATC, acronym in Spanish, 6 studies), OEA followed by PEATC (4 studies), and OEA and PEATC simultaneously (1 study). Two studies recommended OEA, and this method was also the dominant alternative. PEATC was recommended in 4 studies; although only in two of them PEATC was the dominant alternative. Nine studies of cost-effectiveness that compared universal screening with screening in high-risk population were identified. Universal screening was recommended in 7 studies. Only in 3 of them universal screening was the dominant approach. One study recommends hearing screening only in high-risk population. No studies were found about screening for delayed-onset hearing loss in preschool-age children. Current recommendations support UNHS to ensure that infants with confirmed hearing loss will receive appropriate intervention at no later than 6 months of age. Surveillance methods are also required to identify those cases with acquired or progressive hearing loss occurring after the neonatal period. Evidence suggests that CUHN improves language outcomes and quality of life in children with PCHI. More research is needed to confirm these findings. The general expert consensus is that UNHS should be done.

Authors' recommendations: Screening of hearing loss in the framework of a UNHS programme is recommended in order to ensure intervention at no later than 6 months of age for all children with moderate to profound PCHI. Monitoring for progressive and acquired hearing loss is also recommended until three years of age.

Authors' methods: The following databases were searched: PubMed/MEDLINE, EMBASE, and the databases of the Centre for Reviews and Dissemination (CRD): NHS Economic Evaluation Database (NHS EED), Health Technology Assessment Database (HTA), Database of Abstracts of Reviews of Effects (DARE). In addition, the databases of the following health technology assessment agencies, government agencies and scientific societies were also searched: CCOHTA from Canada, NICE from United Kingdom, HTA programme from United Kingdom, MSAC from Australia, AUnETS from the Spanish National Health System, HTA Agencies and Units, U.S. Preventive Services Task Force, UK National Screening Committee, American Academy of Pediatrics, Asociación Española de Pediatría and Asociación Española de Pediatría en Atención Primaria. Subsequently, a manual search from the reference lists of previously identified references was conducted. Complete economic evaluation studies published until October 2012 were selected for the review. CRD databases were further searched for economic evaluations published until December 2013. Experimental and observational studies with a comparison group published until December 2013 were selected for the review. The selection of studies was done according to the previously defined inclusion and exclusion criteria. Those articles that met inclusion criteria were assessed by the computer-assisted critical appraisal tool of the Basque Office for Health Technology Assessment – OSTEBA.

Project Status: Completed

Year Published: 2016

URL for published report: https://www.iacs.es/wp-content/uploads/2017/04/755_IACS_Hipoacusia.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Health Sciences Institute in Aragon (IACS)

Contact Address: Avda, San Juan Bosco, 13, planta 2

Contact Name: María Pilar Calvo Pérez

Contact Email: direccion.iacs@aragon.es