老年人听力干预的经济评估：证据与方法的系统综述
Economic Evaluations of Hearing Interventions in Older Adults: A Systematic Review of Evidence and Methods.
文献信息
| PMID | 42862436 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Smriti Raichand |
| 作者单位 | Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia. |
| 期刊 | Advances in therapy |
| SCI 分区 | Q1 |
| IF | 4.6 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
引言： 年龄相关性听力损失在老年人中很常见，并与较差的生活质量、跌倒、认知和心理社会后果以及医疗保健使用增加相关。助听器、人工耳蜗和康复服务可能改善结局，但其经济价值仍不明确。本系统综述评估了老年人听力干预的成本效果和成本效益证据，并审查了评估中使用的方法、假设和结局指标。
方法： 检索了Medline、Embase、Scopus、Web of Science和EconLit从建库至2026年8月，纳入针对≥60岁成人听力干预的试验或模型为基础的完整经济评估。符合条件的研究包括成本效果分析（CEAs）、成本效用分析（CUAs）和成本效益分析（CBAs）。成本标准化为2024年美元。使用CHEQUE评估CEAs的质量，使用Drummond清单评估CBAs的质量。
结果： 共有28篇文章中的27项研究符合纳入标准，其中22项研究报告了CEAs，包括19项CUAs，6项CBAs；1项研究同时报告了CUA和CBA。CEAs普遍发现人工耳蜗和助听器与无干预相比具有成本效果，并且在符合条件的人群中，人工耳蜗通常与助听器相比具有成本效果。助听器后咨询或康复、经皮骨传导设备和人工耳蜗处理器升级通常具有成本效果。CBAs显示正净货币收益。健康相关生活质量最常使用健康效用指数Mark 3测量。成本通常包括设备、程序和医生就诊费用。关键驱动因素包括效用增益、干预成本、干预时年龄和设备依从性。局限性包括遗漏下游成本、有限的照护者和社会影响、不一致的基于偏好的结局测量、模型验证不足、有限的公平性分析以及没有在机构和长期护理中的评估。
结论： 听力干预，特别是助听器和人工耳蜗，似乎为老年人提供了良好的经济价值。未来的评估应捕捉更广泛的获益、下游成本、照护者和长期护理影响，并使用透明、标准化的方法。
英文摘要
INTRODUCTION: Age-related hearing loss is common among older adults and is associated with poorer quality of life, falls, cognitive and psychosocial consequences, and increased healthcare use. Hearing aids, cochlear implants and rehabilitation services may improve outcomes, but their economic value remains unclear. This systematic review assessed cost-effectiveness and cost-benefit evidence for hearing interventions in older adults and examined methods, assumptions and outcome measures used in the evaluations.
METHODS: Medline, Embase, Scopus, Web of Science and EconLit were searched from inception to August 2026 for trial- or model-based full economic evaluations of hearing interventions in adults ≥ 60 years. Eligible studies included cost-effectiveness analyses (CEAs), cost-utility analyses (CUAs), and cost-benefit analyses (CBAs). Costs were standardised to 2024 US dollars. Quality was assessed using CHEQUE for CEAs and the Drummond checklist for CBAs.
RESULTS: A total of 27 studies in 28 articles met the inclusion criteria, of which 22 studies reported CEAs, including 19 CUAs, and 6 CBAs; 1 study reported both a CUA and a CBA. CEAs generally found cochlear implants and hearing aids to be cost-effective compared with no intervention, and cochlear implants were often cost-effective compared with hearing aids in eligible populations. Post-hearing-aid counselling or rehabilitation, transcutaneous bone conduction devices and cochlear implant processor upgrades were generally cost-effective. CBAs indicated positive net monetary benefits. Health-related quality of life was most commonly measured using the Health Utilities Index Mark 3. Costs typically included device, procedure and physician-visit costs. Key drivers included utility gains, intervention costs, age at intervention and device compliance. Limitations included omission of downstream costs, limited carer and societal impacts, inconsistent preference-based outcome measurement, insufficient model validation, limited equity analysis and no evaluations in institutional and long-term care.
CONCLUSIONS: Hearing interventions, particularly hearing aids and cochlear implants, appear to offer good economic value for older adults. Future evaluations should capture broader benefits, downstream costs, carer and long-term care impacts, and use transparent, standardised methods.