Modeling the cost and performance of early identification protocols.

This is the first in a series of three papers concerned with the early identification of hearing loss. In this paper, a simple model is presented that permits the calculation of the performance and cost of early identification protocols. In the second paper (Turner, in press), this model is used to compare four early identification protocols that differ in hearing screening strategies. The third paper (Turner, in press) examines the factors that influence the early identification protocol. The model described in this paper is sufficiently general to accommodate most early identification strategies including those that meet the goal of identification and habilitation by 6 months. The model measures protocol performance using hit rate, false alarm rate, and selected posterior probabilities. The model also calculates two measures of the financial cost. One measure reflects the cost of implementing the protocol; the other reflects the cost-effectiveness of the protocol. The parameters required by the model are also specified and are based on published clinical data. The model is provided to help audiologists design and select early identification protocols that are optimum for their particular clinical situation.