Cost-effectiveness of selected interventions for hearing impairment in Africa and Asia: a mathematical modelling approach.

The purpose of this paper was to present estimates of costs and effects of selected interventions for hearing impairment in Africa and Asia. The method used mathematical simulation models on the basis of WHO burden of disease information, and WHO-CHOICE costing databases. Findings showed that in both regions, screening strategies for hearing impairment and delivery of hearing aids cost between I$1000 and I$1600 per DALY, with passive screening being the most efficient intervention. Active screening at schools and in the community are somewhat less cost-effective. In the treatment of chronic otitis media, aural toilet in combination with topical antibiotics costs is more efficient than aural toilet alone, and costs between I$11 and I$59 in both regions. The treatment of meningitis with ceftriaxone costs between I$55 and I$217 at low coverage levels, in both regions. In more absolute terms, the vast majority of all considered intervention strategies are cost-effective strategies according to international benchmarks, in both regions concerned. In conclusion, various strategies are economically attractive to reduce the disease burden of hearing impairment around the world.