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Hoeve HLJ, Goedegebure A, Carr G, Davis A, Mackey AR, Bussé AML, Uhlén IM, Qirjazi B, Kik J, Simonsz HJ, Heijnsdijk EAM. Modelling the cost-effectiveness of a newborn hearing screening programme; usability and pitfalls. Int J Audiol 2024; 63:235-241. [PMID: 36799623 DOI: 10.1080/14992027.2023.2177892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE The EUSCREEN project concerns the study of European vision and hearing screening programmes. Part of the project was the development of a cost-effectiveness model to analyse such programmes. We describe the development and usability of an online tool to enable stakeholders to design, analyse or modify a newborn hearing screening (NHS) programme. DESIGN Data from literature, from existing NHS programmes, and observations by users were used to develop and refine the tool. Required inputs include prevalence of the hearing impairment, test sequence and its timing, attendance, sensitivity, and specificity of each screening step. Outputs include the number of cases detected and the costs of screening and diagnostics. STUDY SAMPLE Eleven NHS programmes with reliable data. RESULTS Three analyses are presented, exploring the effect of low attendance, number of screening steps, testing in the maternity ward, or screening at a later age, on the benefits and costs of the programme. Knowledge of the epidemiology of a staged screening programme is crucial when using the tool. CONCLUSIONS This study presents a tool intended to aid stakeholders to design a new or analyse an existing hearing screening programme in terms of benefits and costs.
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Affiliation(s)
- Hans L J Hoeve
- Department of Otorhinolaryngology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gwen Carr
- Independent Consultant in Early Hearing Detection and Intervention, Ribble Valley, UK
| | - Adrian Davis
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | | | - Andrea M L Bussé
- Department of Otorhinolaryngology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Birkena Qirjazi
- Department of Ear, Nose and Throat Diseases - Ophthalmology, University of Medicine of Tirana, Tirana, Albania
| | - Jan Kik
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Otorhinolaryngology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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Bussé AML, Qirjazi B, Mackey AR, Kik J, Goedegebure A, Hoeve HLJ, Toçi E, Roshi E, Carr G, Toll MS, Simonsz HJ. Implementation of Newborn Hearing Screening in Albania. Int J Neonatal Screen 2023; 9:ijns9020028. [PMID: 37218893 DOI: 10.3390/ijns9020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
Newborn hearing screening (NHS) was implemented in Albania in four maternity hospitals in 2018 and 2019. Implementation outcome, screening outcome, and screening quality measures were evaluated. Infants were first screened by midwives and nurses before discharge from the maternity hospital and returned for follow-up screening. Acceptability, appropriateness, feasibility, adoption, fidelity, coverage, attendance, and stepwise and final-referral rates were assessed by onsite observations, interviews, questionnaires, and a screening database. A post hoc analysis was performed to identify reasons for loss to follow up (LTFU) in a multivariate logistic regression. In total, 22,818 infants were born, of which 96.6% were screened. For the second screening step, 33.6% of infants were LTFU, 40.4% for the third, and 35.8% for diagnostic assessment. Twenty-two (0.1%) were diagnosed with hearing loss of ≥40 dB, six unilateral. NHS was appropriate and feasible: most infants are born in maternity hospitals, hence nurses and midwives could perform screening, and screening rooms and logistic support were supplied. Adoption among screeners was good. Referral rates decreased steadily, reflecting increasing skill. Occasionally, screening was repeated during a screening step, contrary to the protocol. NHS in Albania was implemented successfully, though LTFU was high. It is important to have effective data tracking and supervision throughout the screening.
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Affiliation(s)
- Andrea M L Bussé
- Department of Otorhinolaryngology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Birkena Qirjazi
- Department of Ear, Nose and Throat Diseases-Ophthalmology, University of Medicine of Tirana, 1000 Tirana, Albania
| | | | - Jan Kik
- Department of Ophthalmology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Hans L J Hoeve
- Department of Otorhinolaryngology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Ervin Toçi
- Department of Public Health, University of Medicine of Tirana, 1000 Tirana, Albania
| | - Enver Roshi
- Department of Public Health, University of Medicine of Tirana, 1000 Tirana, Albania
| | - Gwen Carr
- Independent Consultant in Early Hearing Detection, Intervention and Family Centered Practice, Ribble Valley BB7 2RA, UK
| | - Martijn S Toll
- Department of Otorhinolaryngology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
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Verkleij ML, Heijnsdijk EAM, Bussé AML, Carr G, Goedegebure A, Mackey AR, Qirjazi B, Uhlén IM, Sloot F, Hoeve HLJ, de Koning HJ. Cost-Effectiveness of Neonatal Hearing Screening Programs: A Micro-Simulation Modeling Analysis. Ear Hear 2021; 42:909-916. [PMID: 33306547 PMCID: PMC8221716 DOI: 10.1097/aud.0000000000000981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Early detection of neonatal hearing impairment moderates the negative effects on speech and language development. Universal neonatal hearing screening protocols vary in tests used, timing of testing and the number of stages of screening. This study estimated the cost-effectiveness of various protocols in the preparation of implementation of neonatal hearing screening in Albania.
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Affiliation(s)
- Mirjam L Verkleij
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrea M L Bussé
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gwen Carr
- Independent Consultant in Early Hearing Detection, Intervention and Family Centered Practice, London, United Kingdom
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Allison R Mackey
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Birkena Qirjazi
- Department of Ear, Nose and Throat Diseases-Ophthalmology, University of Tirana, Tirana, Albania
| | - Inger M Uhlén
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Frea Sloot
- Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hans L J Hoeve
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Genitsaridi E, Dode A, Qirjazi B, Mehdi M, Pryss R, Probst T, Reichert M, Hauck F, Hall DA. An Albanian translation of a questionnaire for self-reported tinnitus assessment. Int J Audiol 2021; 61:515-519. [PMID: 34182868 DOI: 10.1080/14992027.2021.1933221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To our knowledge, there is no published study investigating the characteristics of people experiencing tinnitus in Albania. Such a study would be important, providing the basis for further research in this region and contributing to a wider understanding of tinnitus heterogeneity across different geographic locations. The main objective of this study was to develop an Albanian translation of a standardised questionnaire for tinnitus research, namely the European School for Interdisciplinary Tinnitus Research-Screening Questionnaire (ESIT-SQ). A secondary objective was to assess its applicability and usefulness by conducting an exploratory survey on a small sample of the Albanian tinnitus population. DESIGN AND STUDY SAMPLE Three translators were recruited to create the Albanian ESIT-SQ translation following good practice guidelines. Using this questionnaire, data from 107 patients attending otolaryngology clinics in Albania were collected. RESULTS Participants reporting various degrees of tinnitus symptom severity had distinct phenotypic characteristics. Application of a random forest approach on this preliminary dataset showed that self-reported hearing difficulty, and tinnitus duration, pitch and temporal manifestation were important variables for predicting tinnitus symptom severity. CONCLUSIONS Our study provided an Albanian translation of the ESIT-SQ and demonstrated that it is a useful tool for tinnitus profiling and subgrouping.
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Affiliation(s)
- Eleni Genitsaridi
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, UK
| | - Albi Dode
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Birkena Qirjazi
- Department of ENT, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Muntazir Mehdi
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Manfred Reichert
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Franz Hauck
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Deborah Ann Hall
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, UK.,Department of Psychology, School of Social Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
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Qirjazi B, Toçi E, Tushe E, Burazeri G, Roshi E. Mothers' perceptions of universal newborn hearing screening in transitional Albania. PLoS One 2020; 15:e0237815. [PMID: 32822384 PMCID: PMC7444524 DOI: 10.1371/journal.pone.0237815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
Abstract
The universal newborn hearing screening (UNHS) component of the multi-center EUSCREEN project is being piloted in Albania since January 1st 2018. The aim of this study was to explore mothers’ perceptions about various elements of UNHS in Albania. A cross-sectional study was carried out in the three sites of UNHS in Albania, namely in Tirana, Kukës and Pogradec during May-June 2019. During this period 512 consecutively approached mothers giving birth to included maternity hospitals were interviewed face-to-face about different aspects of UNHS. Basic socio-demographic and socioeconomic information was also collected. Mean age of participating mothers was 28.6 years ± 5.5 years. The overwhelming majority (93%) of mothers knew what their baby was being tested for, 33% were aware that hearing screening was offered in maternity hospital, 94% were very satisfied/satisfied with UNHS and about 62% were very stressed/stressed waiting for screening results, with significant sociodemographic and socioeconomic differences. The main information source about UNHS was screening staff in the maternity hospitals where mothers gave birth, reported in 67% of cases. All mothers (100%) agreed on the importance of early detection of newborn hearing problems, all mothers were willing to be informed early if their newborn baby had a hearing problem and all mothers were willing to contribute financially for testing the hearing of their newborn baby. These findings should guide information and education campaigns about UNHS in Albania. The public willingness to financially support neonatal hearing testing should be considered as an opportunity to achieve universal newborn hearing screening in the country.
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Affiliation(s)
- Birkena Qirjazi
- Faculty of Medicine, University of Medicine, Tirana, Tirana, Albania
- Institute of Public Health, Tirana, Albania
| | - Ervin Toçi
- Faculty of Medicine, University of Medicine, Tirana, Tirana, Albania
- Institute of Public Health, Tirana, Albania
- * E-mail:
| | - Eduard Tushe
- University Maternity Hospital “Koço Gliozheni”, Tirana, Albania
| | - Genc Burazeri
- Faculty of Medicine, University of Medicine, Tirana, Tirana, Albania
| | - Enver Roshi
- Faculty of Medicine, University of Medicine, Tirana, Tirana, Albania
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Bussé AM, Qirjazi B, Goedegebure A, Toll M, Hoeve HL, Toçi E, Roshi E, Carr G, Simonsz HJ. Implementation of a neonatal hearing screening programme in three provinces in Albania. Int J Pediatr Otorhinolaryngol 2020; 134:110039. [PMID: 32304854 DOI: 10.1016/j.ijporl.2020.110039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/13/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The EUSCREEN study compares the cost-effectiveness of paediatric hearing screening programmes and aims to develop a cost-effectiveness model for this purpose. Alongside and informed by the development of the model, neonatal hearing screening (NHS) is implemented in Albania. We report on the first year. METHODS An implementation plan was made addressing objectives, target population, screening protocol, screener training, screening devices, care pathways and follow up. NHS started January 1st, 2018 in four maternity hospitals: two in Tirana, one in Pogradec and one in Kukës, representing both urban and rural areas. OAE-OAE-aABR was used to screen well infants in maternity hospitals, whereas aABR-aABR was used in neonatal intensive care units and in mountainous Kukës for all infants. Screeners' uptake and attitudes towards screening and quality of screening were assessed by distributing questionnaires and visiting the maternity hospitals. The result of screening, diagnostics, follow up and entry into early intervention were registered in a database and monitored. RESULTS Screeners were keen to improve their skills in screening and considered NHS valuable for Albanian health care. The number of "fail" outcomes after the first screen was high initially but decreased to less than 10% after eight months. In 2018, 11,507 infants were born in the four participating maternity hospitals, 10,925 (94.9%) of whom were screened in the first step. For 486 infants the result of screening was not registered. For the first screen, ten parents declined, eight infants died and one infant was discharged before screening could be performed. In 1115 (10.2%) infants the test either could not be performed or the threshold was not reached; 361 (32,4%) of these did not attend the second screen. For the third screen 31 (34.4%) out of 90 did not attend. Reasons given were: parents declined (124), lived too far from screening location (95), their infant died (11), had other health issues (7), or was screened in private clinic (17), no reason given (138). CONCLUSIONS Implementation of NHS in Albania is feasible despite continuing challenges. Acceptance was high for the first screen. However, 32.4% of 1115 infants did not attend the second screen, after a "fail" outcome for the first test.
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Affiliation(s)
- Andrea Ml Bussé
- Erasmus University Medical Center Rotterdam, Department of Ophthalmology, Rotterdam, the Netherlands; Erasmus University Medical Center Rotterdam, Department of Otorhinolaryngology, Rotterdam, the Netherlands.
| | - Birkena Qirjazi
- University of Medicine of Tirana, Department of Ear, Nose and Throat Diseases - Ophthalmology, Tirana, Albania
| | - André Goedegebure
- Erasmus University Medical Center Rotterdam, Department of Otorhinolaryngology, Rotterdam, the Netherlands
| | - Martijn Toll
- Erasmus University Medical Center Rotterdam, Department of Otorhinolaryngology, Rotterdam, the Netherlands
| | - Hans Lj Hoeve
- Erasmus University Medical Center Rotterdam, Department of Otorhinolaryngology, Rotterdam, the Netherlands
| | - Ervin Toçi
- University of Medicine of Tirana, Department of Public Health, Tirana, Albania
| | - Enver Roshi
- University of Medicine of Tirana, Department of Public Health, Tirana, Albania
| | - Gwen Carr
- Independent Consultant in Early Hearing Detection, Intervention and Family Centered Practice, London, United Kingdom
| | - Huibert J Simonsz
- Erasmus University Medical Center Rotterdam, Department of Ophthalmology, Rotterdam, the Netherlands
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Abstract
The paper describes the outcomes of an ongoing universal hearing screening program in Tirana, Albania. The main objectives of the project were the evaluation of the feasibility of a neonatal hearing screening program in Albania, and an evaluation of the prevalence of risk factors in the NICU environment. One thousand five hundred and sixty-one (1561) infants from both the WB and NICU were screened with transient evoked otoacoustic emissions (TEOAE). A detailed history of risk factors was collected in each case, thus it was possible to evaluate the main factors influencing the output of the screening program. It was concluded that the program had the capacity to identify infants with congenital hearing loss provided that an informative component is well-structured and delivered. Also, although the prevalence of risk factors appeared high, the reduction of 'case leakage' would allow the precise estimation of the incidence of hearing loss in the Albanian population.
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MESH Headings
- Albania
- Audiometry, Evoked Response
- Cross-Sectional Studies
- Feasibility Studies
- Female
- Health Knowledge, Attitudes, Practice
- Hearing Loss/congenital
- Hearing Loss/diagnosis
- Hearing Loss/epidemiology
- Hearing Loss/rehabilitation
- Hospitals, Maternity
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/rehabilitation
- Intensive Care Units, Neonatal
- Male
- Neonatal Screening
- Otoacoustic Emissions, Spontaneous
- Referral and Consultation/statistics & numerical data
- Risk Factors
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