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. ACKNOWLEDGMENTS: The author thanks Elliott Berger (3M Company) and Dennis Driscoll (Associates in Acoustics), who offered comments on a draft manuscript, and Howard Hoffman and Katalin Losonczy (National Institute on Deafness and other Communication Disorders, NIDCD), who provided statistical analyses of recent national health survey data sets collected by the National Center for Health Statistics via co-sponsorship and funding from NIDCD. The author has a private consulting practice (http://ift.tt/2pFajjj) in hearing conservation; no client was aware of this article prior to submission for publication. Address for correspondence: Robert A. Dobie, 214 Morton Street, San Antonio, TX 78209. E-mail: dobie@uthscsa.edu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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