Cost Analysis of an Annual School-Based Pediatric Hearing Screening Program in Semi-Rural Kenya
Nicole Kloosterman1, Kevin N Griffith2, Kristen Yancey3
1Vanderbilt University School of Medicine, Nashville, TN, USA.
Insights
Preventable childhood hearing loss in Sub-Saharan Africa is a major concern. This study details the cost of a pediatric hearing program in Kenya, finding a mean cost of $212 per diagnosis and projecting expansion costs.
Area of Science:
- Global Health
- Pediatric Audiology
- Health Economics
Background:
- Disabling hearing loss affects 8.9 million children in Sub-Saharan Africa, representing 11% of global pediatric hearing healthcare costs.
- A significant portion (75%) of hearing loss in children from Low- and Middle-Income Countries (LMICs) is preventable.
Purpose of the Study:
- To evaluate the intervention and expansion costs of a pediatric hearing health and screening program in Malindi, Kenya.
- To determine the mean cost per identified case of hearing loss and project scale-up costs for wider implementation.
Main Methods:
- A cost analysis was performed from the provider's perspective for a humanitarian program.
- Sensitivity analyses (one-way and Monte Carlo simulation) were used to assess cost variations.
- The study screened 155 children aged 5-16 years in four schools.
Main Results:
- 5.8% of screened children were diagnosed with hearing impairment.
- The total implementation cost was $6,783 USD, with a mean cost of $212 per hearing loss diagnosis.
- Key cost drivers included resident travel, audiometric testing equipment, and maintenance; projected expansion to 77 schools is $130,573.
Conclusions:
- The intervention identified higher-than-average rates of childhood hearing loss, providing crucial cost-estimation for program expansion.
- Humanitarian aid is vital for the sustainability and feasibility of scaling up such pediatric hearing health initiatives.
Introduction:
Approximately 8.9 million children in Sub-Saharan Africa have disabling hearing loss, accounting for 11% of the global child healthcare hearing costs. For children living in Low- and Middle-Income Countries (LMICs), 75% of hearing loss is preventable.
Methods:
We evaluate the overall intervention and expansion costs of a humanitarian, pediatric hearing health and screening program in Malindi, Kilifi County, Kenya. A cost analysis is conducted from the provider perspective, identifying the mean cost incurred for each case of newly identified hearing loss. Estimates were made for 3 different cost scenarios. A one-way sensitivity analysis and probabilistic sensitivity analysis using Monte Carlo simulation determined the impact of variations in individual cost parameters. These results were used to project scale-up costs to achieve sub-county expansion of the program.
Results:
155 children ages 5 to 16 years old were screened, of which 5.8% were diagnosed with hearing impairment. The total cost for implementation in four schools was $6,783 USD, thus a mean cost of $212 per diagnosis of hearing loss. The highest proportion of costs were recurrent costs of resident travel (27.9%), capital costs for providing audiometric testing (25.3%), and equipment maintenance (18.7%). Expansion of an exclusively CHW-run program across all 77 primary public schools in Malindi is projected to be $130,573 (range $119,352 to $142,240).
Conclusion:
We provide relevant cost-estimation for an expansion of an intervention which identified higher than average rates of hearing loss. Humanitarian aid plays a key role in the sustainability and feasibility of expanding this program.
