Learning Objectives:
Introduction: The NHS Commissioning Policy on Bone Anchored Hearing Aids (BAHA) identifies the criteria for the commissioning of BAHA services and therefore has a major impact on patient access to care. This paper aims to evaluate the evidence base informing the NHS Commissioning Policy on BAHAs. We also aim to produce recommendations on BAHA policy development.
Methods: This study was conducted in two parts.
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1) Critical assessment of the evidence based informing the NHS Commissioning Policy on BAHAs. Quality of included articles and the overall strength of the policy were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) System.
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2) Systematic review of the literature on BAHAs published since the release of NHS Commissioning Policy. Papers were included if they could be used to inform the Commissioning Policy on BAHAs.
Results: All studies referenced by the policy were graded as ‘low quality’ or ‘very low quality’ evidence. The strength of the overall policy was graded as weak. The literature cited by the Commissioning Policy contained several areas of disagreement with the Commissioning Policy itself.
Nineteen articles were included following systematic review. These studies identified six areas for development of the NHS Commissioning Policy for BAHAs: 1) BAHA implantation in children with unilateral hearing loss; 2) BAHA as an alternative to other surgical treatments; 3) The minimum number of BAHAs implanted by a centre each year; 4) Unilateral BAHA implantation in patients with less than profound sensorineural hearing loss; 5) Bilateral BAHA implantation in adults; 6) BAHA implantation in patients with osteogenesis imperfecta.
Conclusion: It is important that these areas are reviewed by the commissioning board to help ensure equitable access to BAHA services and that resources are allocated effectively. It is also clear that high quality research is urgently needed in this field to help inform national policy.
