Cost-Effective Hearing Conservation: Regulatory and Research Priorities.

Hearing conservation programs (HCPs) mandated by the US Occupational Safety and Health Administration (OSHA) cost about $350/worker/year. Are they cost-effective? A cross-sectional model of the US adult population with and without HCPs incorporates (1) the American Medical Association's method for estimating binaural hearing impairment and whole-person impairment; (2) the model of the International Organization for Standardization (ISO) for estimating both age-related and noise-induced hearing loss; and (3) an acceptable cost of $50,000 per quality-adjusted life year. The ISO model's outputs were audiometric thresholds for groups of people with different age, sex, and noise exposure history. These thresholds were used to estimate cost per quality-adjusted life year saved for people in HCPs with different noise exposure levels. Model simulations suggest that HCPs may be cost-effective only when time-weighted average (TWA) noise exposures are ≥ 90 dBA. Enforcing existing regulations, requiring engineering noise control at high exposure levels, and using new methods that can document hearing protection device performance could improve cost-effectiveness. If the OSHA action level remains at 85 dBA-TWA, reducing the permissible exposure limit to the same level would simplify management and slightly improve cost-effectiveness. Research should evaluate employer compliance across industries, determine whether workers currently excluded from HCP regulations are at risk of noise-induced hearing loss, and develop cost-effective HCPs for mobile workers in construction, agriculture, and oil and gas drilling and servicing. Research on HCP cost-effectiveness could be extended to incorporate sensitivity analyses of the effects of a wider range of assumptions.

Economic Burden of Hearing Loss for the U.S. Military: A Proposed Framework for Estimation.

The goal of this multiphased research is to develop methods to comprehensively determine the economic impact of hearing impairment and noise-induced hearing injury among active duty U.S. Service Members. Several steps were undertaken to develop a framework and model for economic burden analysis: (1) a literature review identifying studies reporting the cost of health conditions and injuries in the Department of Defense, (2) consultation with a panel of subject matter experts who reviewed these cost items, and (3) discussions with DoD data stewards and review of relevant data dictionaries and databases. A Markov model was developed to represent the cumulative economic effect of events along the career span, such as retraining after hearing impairment and injury, by synthesizing inputs from various sources. The model, as developed and proposed in this study, will be a valuable decision-making tool for the DoD to identify high-risk groups, take proactive measures, and develop focused education, customized equipping, and return-to-duty and reintegration programs, thereby maximizing the retention of skilled, experienced, and mission-ready Service Members.

Modeling the Unites States government's economic cost of noise-induced hearing loss for a military population.

OBJECTIVE: The purpose of this paper is to demonstrate the feasibility and utility of developing economic cost models for noise-induced hearing loss (NIHL). First, we outline an economic model of NIHL for a population of US Navy sailors with an "industrial"-type noise exposure. Next, we describe the effect on NIHL-related cost of varying the two central model inputs--the noise-exposure level and the duration of exposure. Such an analysis can help prioritize promising areas, to which limited resources to reduce NIHL-related costs should be devoted. METHODS: NIHL-related costs borne by the US government were computed on a yearly basis using a finite element approach that took into account varying levels of susceptibility to NIHL. Predicted hearing thresholds for the population were computed with ANSI S3.44-1996 and then used as the basis for the calculation of NIHL-related costs. Annual and cumulative costs were tracked. Noise-exposure level and duration were systematically varied to determine their effects on the expected lifetime NIHL-related cost of a specific US Navy sailor population. RESULTS: Our nominal noise-exposure case [93 dB(A) for six years] yielded a total expected lifetime cost of US $13,472 per sailor, with plausible lower and upper bounds of US $2,500 and US $26,000. Starting with the nominal case, a decrease of 50% in exposure level or duration would yield cost savings of approximately 23% and 19%, respectively. We concluded that a reduction in noise level would be more somewhat more cost-effective than the same percentage reduction in years of exposure. CONCLUSION: Our economic cost model can be used to estimate the changes in NIHL-related costs that would result from changes in noise-exposure level and/or duration for a single military population. Although the model is limited at present, suggestions are provided for adapting it to civilian populations.

Efficacy of a low cost protocol in reducing noise levels in the neonatal intensive care unit.

OBJECTIVE: To examine the effectiveness and cost of implementing a noise reduction protocol in a level III neonatal intensive care unit (NICU). METHODS: A prospective longitudinal study was done in a level III NICU, wherein a noise reduction protocol that included behavioral and environmental modification was implemented. The noise levels were measured sequentially every hour for 15 days before and after this intervention. The statistical significance of the reduction in noise levels after implementation of the protocol was tested by paired sample student's t-test. Cost was calculated using the generalized cost effectiveness model of the World Health Organisation. The present study has 80% power with 95% confidence to measure 2 dB differences between groups for the maximum recommended of 50 dB. RESULTS: The protocol in the present study reduced noise levels in all the rooms of the NICU to within 60 dB with high statistical significance (p< 0.001). The extent of noise reduction in the rooms of the NICU was as follows: ventilator room by 9.58 dB (95% confidence interval: 6.73-12.42, p < 0.001), stable room by 6.54 dB (95% confidence interval: 2.92-4.16, p < 0.001), isolation room by 2.26 dB (95% confidence interval: 1.21-3.30, p < 0.001), pre-term room by 2.37 dB(95% confidence interval: 1.22-3.51, p < 0.001) and extreme preterm room by 2.09 dB (95% confidence interval: 1.14-3.02, p < 0.001). The intervention was most cost-effective in the ventilator room, requiring Rs. 81.09 to reduce 1 dB and least effective in the extreme pre-term room requiring Rs. 371.61 to reduce 1 dB. CONCLUSION: The high efficacy and affordability of noise reduction protocols justify the need for implementation of these measures as a standard of care in neonatal intensive care units.

Design of optimal noise hazard control strategy with budget constraint.

An analytical design procedure to determine optimal noise hazard control strategies for industrial facilities is presented. Its objective is to determine a set of appropriate noise controls to eliminate or reduce noise levels so that workers' daily noise exposure does not exceed a permissible level. From a given noise control budget, engineering controls will be firstly implemented, followed by administrative controls, and then the use of hearing protection devices. Six optimization models are developed and sequentially applied to select appropriate noise controls without exceeding the budget. Numerical examples are presented to demonstrate the application of the proposed design procedure.

Does your audiometric monitoring program measure up?

All hearing conservation programs under CFR 1910.95 require audiometric monitoring. This article provides an overview of OSHA noncompliance citations related to audiometric monitoring and associated monetary penalties reported between January 1988 and June 1994. The data in this article reflect the degree of seriousness of different elements of noncompliance, because monetary penalties, at least empirically, are related to severity or importance of the element.