translating innovation in hearing loss prevention and improved remediation to improved patient...

creating sound valueTM

Translating Innovation in Hearing Loss Prevention and Improved Remediation to

Improved Patient Outcomes Prof Bob Cowan

The HEARing Cooperative Research Centre, Australia Depts of Otolaryngology & Audiology, The University of Melbourne, Australia

Macquarie University, Sydney, Australia

www.hearingcrc.org creating sound valueTM www.hearingcrc.org


Clinical trial

Investigator led research

Evidence-based research

Qualitative research

study

Translational research

Defining Terms: “research….”

Outcomes study

Impact

Pilot study

“Buzz-word City”!

Innovation


Understanding Innovation and Impact

Improved Product

Improved Process

Improved Service

Identification of a Problem (Opportunity)

Use of Outcome creates Impact

Ideas to solve it

Knowledge transfer

(scientifically-supported clinical investigation)

Translational research – bridge from theory to clinical treatment

(evidence-based change to clinical practice)


Innovation Scoreboard

“Australia lags well behind in translating and commercialising research in comparison to leading OECD countries” May 2014


Barriers to Innovation

Knowledge Barriers Market Barriers Cost Barriers

Lack of qualified personnel

Difficulty in finding cooperative partners

Lack of information on markets

Lack of information on technology

Uncertain demand for innovative goods or services from potential end-users

International markets dominated by one established player

Lack of funds and resources within single organisations

Lack of external finance to acquire infrastructure or to collaborate

High innovation costs

Source: 2008 National Innovation Survey, AusInnovations

Lack of experience in managing large collaborations

“…. Effective collaboration between business and research organisations can benefit from independent facilitation to build trust/momentum between parties


Cooperative Research Centres Program

Industry &

Other End-Users

University &

Research Institutes

& Agencies

Competitive Advantage

Knowledge & Teaching

C R C

• Synergy created by interdisciplinary collaboration, pooling infrastructure • Adequate time frames (9 year average time lag to impact) • Scale of the effort to address sector-wide issues/challenges • User-focused drive ensures ready utilisation of outcomes • Research leadership – bringing skills together


Medical Sector CRCs


Public – prevention of injury / disease

Patients – improved / novel diagnostic, treatment or rehabilitative services

Physicians / health professionals – knowledge & technology to improve services

Industry – pharmaceutical /medical devices

Hospitals / health services – enhanced delivery models for clinical healthcare practice

Government – evidence-based research guiding policy decisions

Med Sector CRCs – many end-users

Key challenge for a CRC is to identify end-users across sector

creating sound valueTM creating sound valueTM

9

The HEARing Cooperative Research Centre (CRC) is focused on the twin challenges of:

• more effective prevention; and

• improved remediation of hearing and communication disability. Aims Through research and its use, the HEARing CRC aims to reduce the economic impact of hearing loss by focusing member’s expertise on:

• maximising lifelong hearing retention • reducing loss of productivity resulting from hearing disability • increasing uptake and use of hearing technology; and • providing postgraduate and professional education and training to support uptake and use of prevention and remediation initiatives.

The Strategic Vision


Hearing Disorder vs Hearing Disability

10

Understanding Soundwaves

HEARING DISORDER: What’s wrong with the auditory pathway

HEARING DISABILITY: What a person cannot do as a consequence…


Hearing Disability A global problem

5.3% of the world’s population have a disabling hearing loss

80% of adults over 80 years of age have a hearing disorder that degrades their communication and increases isolation, known factors contributing to cognitive decline

“hearing loss is a significant issue affecting all Australians across their lifetime”*

delaying language development and impacting educational achievement; reducing productivity, employment, leisure and social participation; accelerating cognitive decline.

CHILDREN

ADULTS

ELDERLY

3

* Australian Senate enquiry “Hear Us”, 2010


Age -

20

40

60

80

100

120

140

160

0 20 40 60 80 100

Thou

sand

s

2030 4.8m2020 3.8m2011 3.1m

TOTAL AFFECTED

Aus

tralia

ns w

ith h

earin

g lo

ss

12

>88% increase in numbers of people over 65 with hearing loss over the next 20 years

Hearing loss accelerates cognitive decline

Hearing Disability A future epidemic


Long-Term Evidence-based Studies

Ching, NAL, Hearing CRC

LOCHI

… critical need for evidence-base modelling of economic impact of hearing aid fitting in children (as well as adults & elderly)

Dr Teresa Ching

creating sound valueTM Source: “Listen Hear Australia”, Access Economics 2006

Hearing Disability and Economic Impact

Deadweight tax losses

Education and support services

Direct health care costs

Cost of informal carers

57% 27%

8% 6%

2% Deadweight tax losses

Education and support services

Direct health care costs

Cost of informal carers

Productivity & direct employment

57% 27%

8% 6%

2%

Contributors to financial impact

$11.75bn p.a. financial impact $11.30bn p.a. disability & lost well- being impact $23.05bn p.a.

Economic Impact of Hearing Loss on Australia

+

key to successful translation is shared view of MAJOR CHALLENGE that we are addressing


Treating Hearing Disorders “Clinician-centric” treatment of sensory issues

15

Soundwaves Understanding

DEVICE SELECTION

DEVICE FITTING (RE)HABILITATION DIAGNOSIS

CLINICIAN-DRIVEN SENSORY ISSUE FOCUSED

CURRENT MODEL

PREVENTION


Age

Preventing Hearing Disability The need for integrated intervention

16

Per

form

ance

Sensing Understanding

Timely sensing and cognitive intervention to use the brain’s neuroplasticity is critical to maintaining/restoring functional communication and minimising cognitive degeneration

… added rehabilitation improves outcomes

…but cannot overcome neural degradation that

reduces processing ability

…current intervention overcomes “sensing” deficit by providing a

hearing prosthesis

Understanding declines over time with loss in sensing performance…


SENSING

Preventing Hearing Disability The need for integrated intervention

17

Auditory Processing Disorders (APD) can result from problems with one or many parts of the brain

UNDERSTANDING

APD affects ten times more children than sensory hearing loss or: 1 in 20 school age children and Six times higher in the indigenous

population

Those with APD: Are “functionally hearing impaired” when

trying to listen to one speaker with even low levels of background noise i.e. a classroom have problems localising sound in their

environment – making it hard to engage socially and in sport and just be safe may have great difficulty learning


Individualised Solutions

Enhanced Services Capacity

The Listening Brain

The Intelligent Interface

The Research Program

18

1.1 Device impact on communications 1.2 APD and communications 1.3 Deficits and language

2.1 Better intelligibility 2.2 Electro-neural interface 2.3 Delivery systems for molecular therapy

3.1 Optimising candidacy 3.2 Individualising fitting 3.3 Tailored therapies

4.1 Enabling equal access 4.2 Empowering users 4.3 Hearing loss prevention

Hearing aids and cochlear implants that work better with noise, tonal languages and music and with better manufacturability

Using new insights on brain function to develop new tools to accurately diagnose and target remediation

Continuation of the LOCHI Study

Evidence-based patient-centric guidelines for candidacy, fitting and rehabilitation that best match technology and services to individual needs

Automated self-fitting devices and web-based hearing healthcare delivery models to engage end-users, ensure equal access, and provide regional/rural career opportunities


Treating Hearing Disability What a new Hearing Healthcare model means

INTERVENTION PLANNING

DEVICE FITTING

THERAPY / REHABILITATION

PREVENTION & DIAGNOSIS

USER-CENTRIC | SENSORY + COGNITION FOCUS

10

Timely disability identification • sensory • APD Action before

irreversible cognitive degradation

Integrated intervention • devices • therapies Tailored to

individual needs

Individualised Automated Self-fitting devices User-centric

Combined, tailored rehabilitation and cognitive therapy User-driven

online/remote Delivered cost-effectively

where-ever there is need

NEW MODEL


SYDNEY CLUSTER

MELBOURNE CLUSTER

BRISBANE CLUSTER

HEARing CRC Members

20

hear and say centre

This research was financially supported by the HEARing CRC established and supported under the Australian Government’s Cooperative Research Centres Program

www.hearingcrc.org


An internationally unique consortium of skills and expertise

Building our Strengths

Bio-molecular & biomaterials

Bioengineering / surgical expertise

Clinical trial network / aged care expertise

Electrophysiology / acoustics expertise

Sound coding / engineering expertise

Linguistics / psychology expertise

MEG imaging & functional imaging capability

Collaborative research management framework

21

Expanded rural/ remote trials

3D “real world” facility spatio-acoustic testing

MEG III imaging for cochlear implant

Infant and tonal language experts

Existing strengths

New capabilities

Extended SME engagement

International Linkages


Treating Hearing Disability What a new Hearing Healthcare model means

INTERVENTION PLANNING

DEVICE FITTING

THERAPY / REHABILITATION

PREVENTION & DIAGNOSIS

USER-CENTRIC | SENSORY + COGNITION FOCUS

10

Timely disability identification • sensory • APD Action before

irreversible cognitive degradation

Integrated intervention • devices • therapies Tailored to

individual needs

Individualised Automated Self-fitting devices User-centric

Combined, tailored rehabilitation and cognitive therapy User-driven

online/remote Delivered cost-effectively

where-ever there is need

NEW MODEL

hear and say centre

creating sound valueTM 23

University of Auckland

Chinese University of Hong Kong

New York University Medical Centre Washington University University of Iowa Massachusetts Institute of Technology Sick Childrens Hospital – Toronto University of Western Ontario Mayo Clinic U Wisconsin U of Texas Cochlear Corp

CTC Belgium Medizinische Hochshuule Hannover University of Freiburg University of Manchester Tel Aviv University

Kanazawa Institute of Technology

International Members selected on basis of complimentary skills or market entry

• The Hearing CRC collaborates with key international hearing researchers who are opinion leaders.

International Collaborators

Beijing Culture & Language University


PROGRAM 1: The Listening Brain 2: The Intelligent Interface 3: Individualised solutions 4: Enhanced Service Capacity

PROJECT Devi

ce im

pact

on

com

mun

icatio

nsAP

D an

d co

mm

unica

tions

Defic

its a

nd

lang

uage

Bette

r in

telli

gabi

lity

Elec

tron

eura

l in

terfa

ce

Mol

ecul

ar th

erap

y

Optim

ising

ca

ndid

acy

Indi

vidu

alisi

ng

fittin

g

Tailo

red

ther

apie

s

Enab

ling

equa

l ac

cess

Empo

wer

ing

user

s

Hear

ing

loss

pr

even

tion

1.1 1.2 1.3 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3

RESEARCH & EDUCATIONMacquarie University NAL University of Melbourne Bionics Institute MCRI University of Queensland University of Sydney University of Western Sydney University of Wollongong

INDUSTRY END USERSCochlear Siemens Attune Hybrid Electronics Neuromonics

CLINICAL END USERSACCIH Audiology Australia Hear & Say Neurosensory RIDBC RVEEH SCIC & partners The Shepherd Centre VicDeaf

PATIENT END USERSChildren Adults Aged

Managing & Enhancing Collaboration

24

Cross-program collaboration

End-users “pull” industry + clinical end-users

Project outcomes for all end users

Project collaboration


5 Year Program Economics Leverage & Returns

25

TOTAL PROGRAM = $121m SOURCE OF FUNDS

$m

28

32.5

60.5

CRC

RESEARCH &

INSTITUTES INDUSTRY

38

30

40

13

APPLICATION OF FUNDS $m

420 FTE 14 PhD, 8 top-ups

+ commercial reinvestment $ from HEARworks ($7m to date)

+ other grants/funds $662k from NSW MDF $100k from NSW Gov’t $41k from Australia-China SRF

BENEFIT / COST RATIO

PROGRAM

3.9 TOTAL $ return to

participants

3.7

3.0

3.8

7.4

THE LISTENING BRAIN

INTELLIGENT INTERFACE

INDIVIDUALISED SOLUTIONS

ENHANCED SERVICE CAPACITY


Program Impact

26

Listening Brain

Intelligent Interface


Enhanced Service Capacity

ECONOMIC IMPACT $m NPV

670

1,170

2,800

1,240

Disability Adjusted Life Year (DALY) reduction $m NPV

990

1,260

8,320

2,570

HEALTH IMPACT

• Productivity improvement • Reduced carer costs • Reduced costs special education • Reduced medical costs • NPV – effect on cashflow of new products

• DALY = YLL + YLD - YLL – years of life lost - YLD – years of life disabled

• Attributed only YLD benefit • Reduction in DALYs after

innovation vs before


Investment into Impact A credible track record

27

38 PhDs 40% to industry

600 online registered clinical users

6,000 Australians completed on-line testing

CRCs are about ‘investment’ and ‘impact’

HEARLab®

Shriek Rejection™

$7m reinvested in

CRC research & infrastructure

Trainable Hearing Aid

Advance™ & Hybrid-L CI Electrode Arrays

NAL-NL2

Cochlear Implant

Workshop Program

3,400 surgeons & clinicians from

Asia-Pacific trained


Translation Creating outcomes to achieve impact

28

INDUSTRY: Eliminating barriers to collaboration and take-up

CLINICAL SERVICES: Ensuring clinical application and end-user take-up

Existing strengths

New capabilities

Added layer of project / IP process enabling “company-sensitive” projects in CRC

Builds on HEARnet and HEARnet Learning to raise awareness of research outcomes and encourage take-up by clinicians/agencies

Builds on successful IP and commercial processes - first rights to negotiate licences - third-party licences - potential for spin-off creation - contract research projects

Expanding community and engagement to new SMEs


29

Ensuring a Return from our Research

www.hearingcrc.org


MEDIA

Translation Creating a new awareness & policy environment

30

Social media

Science Meets Parliament Office of Hearing

Services Committee

Senate Enquiry into Hearing

Health

Awareness campaigns


Sound Check Australia



Survey


Hearing Check


OR


Total participants registered: 10,091

Dataset: The basics


Started Completed Completion Rate

Survey 9917 8015 80.8%

Hearing Test 7032 6181 87.8%

Survey+Test 9917 6181 62.3%


10 Ototoxic

Substances

2929

5 Full noise history: work

and leisure

5987

8 Personal

Audio Device use

4315

6 Social impact

of HL

3125

4 & 4.1 Attitudes to

noise for 15-17s & 18-25s

2620

9a Clubbing

preferences

551

1 Demographics

2 Hearing & general

health

3 Recent Noise Exposure: Work, Leisure,

& Personal audio device (PADs) + + = 9234

9b Gigging

preferences

375

10 Ototoxic

Substances

2929

5 18-25s’ Full

noise history work & leisure

5987

8 Personal

Audio Device use

4315

6 Social impact

of HL

3125

4 & 4.1 Attitudes to

noise for 15-17s & 18-25s

2620

9a Clubbing

preferences

551

Participants per Module

1 Demographics

2 Hearing health &

symptoms

3 Recent Noise Exposure Work & Leisure

+ + = 9234

9b Gigging

preferences

375


551 respondents

Attended nightclubs at least twice per month

Mean age: 24.1 years

Males: 57% Females: 43%

A quick dip into “Nightclub” Module


maybe a little 56%

a lot 40%

not sure 1%

not at all 3%

Is the noise level at nightclubs harmful to your hearing?


0%

5%

10%

15%

20%

25%

30%

TTS tinnitus

never occasionally sometimes frequently always

39% 43%

Have you ever… noticed that you were not able to hear as well as usual, or that your ears felt ‘blocked’ or ‘dull’… experienced tinnitus (ringing in your ears)… following a visit to a nightclub?

Nightclubbers’ symptoms



How do you find the music?


not loud enough

2%

just right 13%

loud but tolerable

59%

louder than liked

26%

0

2

4

Louderthanliked

Loud buttolerable

Just rightSy

mpt

om S

core

(out

of 5

)

Attitude to noise is related to symptoms of hearing damage


0%

25%

50%

When I go out clubbing, I want to chat with my friends as well as dance so I'd prefer it if there were some quieterplaces to sit and chat when we're taking a break.

strongly disagree disagree neutral agree strongly agree

84%

Can we have some quiet, please?


Translation Education to build skills and create new end-users

40

POSTGRADUATE: Industry-ready graduates with additional skills in project management & IP

PROFESSIONAL: Up-skilling working professionals Enabling new careers in regional & rural communities

Existing strengths

New capabilities

CRC Mentors program

PhD, MClinAud, MEd programs with multidisciplinary / end-user supervision Fully integrated into research Value-add skills development

program Biomed Research Management

Cochlear Implant & Hearing Technology Workshops International Symposia HEARnet & HEARnet Learning

Expanded accredited on-line continuing professional development (CPD) program Regional/rural Clinical Internship

Support Program


Supporting Audiology Australia CPD


HEARnet & HEARnet Learning


56% of GPs surveyed do not routinely evaluate their patients for hearing loss

Main reasons for not routinely evaluating hearing loss:

GP Survey Results (n=191)

53%

45%

25%

0% 10% 20% 30% 40% 50% 60%

Insufficient time

No testing equipment in practice

Only evaluate if patient reports a hearing problem


47%

38%

24%

20%

19%

0% 10% 20% 30% 40% 50%

Methods used by GPs to evaluate hearing

Whisper/watch tick test

Tuning fork

Audiogram in office

Patient self assessment

Audioscope

Issue: how to better inform or educate GPs about effective hearing screening options?


GPs and Hearing Health – Australian context

0%

10%

20%

30%

40%

50%

60%

70% DisagreeNeutralAgreeStrongly Agree

HAs an effective rehabilitation tool

Difficulty adjusting to HAs

Costs of HAs is too high

Gilliver & Hickson, Int J Audiol. 2011

GP Perceptions on Barriers to Hearing Aid Use


Self-Reported Knowledge

HIGH/ ABOVE AVG

AVERAGE BELOW AVG/LOW

Hearing Aids 18.7% 56% 25.3% Cochlear Implants 6.6% 29.7% 63.8% Sensorineural HL 17.6% 67% 14.3% Conductive HL 24.2% 65.9% 8.8% Age Related HL 20.9% 73.6% 5.5% Tinnitus 31.9% 59.3% 7.7% Tinnitus Management 22% 54.9% 22% Decreased Sound Tolerance 6.6% 47.3% 46.2% CAPD 2.2% 30.8% 67.1%

Broad distribution of knowledge on hearing health topics; Clear opportunity for providing further education to Australian GPs.


Where do GPs obtain their information on Hearing Loss?

Information Sources

83% of GPs surveyed would use a hearing health-based online training module as part of their ongoing career professional development requirements.

54%

49%

26%

24%

18%

0% 10% 20% 30% 40% 50% 60%

Medical journals

Ask a colleague

Australian Hearing

Internet search

GP conferences


“Learning” area: Mixed Hearing Loss


“Technology” area: Middle Ear Implant


A New Era in Hearing Healthcare

50

THE NEED: A new model of hearing healthcare that delivers… Disability Prevention

Intervention before irreversible degradation

Integrated Intervention Sensory + cognitive

Patient-centric Model Tailoring service to individual need

Effective Outreach Accessible, efficient, tailored services – for Australians of all ages


Enhanced Services Capacity

The Listening Brain

The Intelligent Interface

Changing our Hearing Healthcare model will unlock great value for Australians Only a collaboration involving all end-users in the

hearing healthcare chain can change the model Both research and translation are needed to

create the framework for change The CRC is the only program enabling and

leveraging this scale of sector-wide collaboration

THE PROGRAM

THE RATIONALE


Benefits….

combined knowledge multidisciplinary teams ~ novel approaches ~ new skills

market driven shared infrastructure focused on achieving of outcome & return project management

Challenges….

creating shared “culture” building trust (takes time) agreeing ~ research, IP, staff technology transfer, funds

long-term commitment less autonomy & control geographic issues complexity

Managing Collaboration to Impact


Magnetoencephalographic Imaging (MEG)

• The child MEG system at CCD is a custom sized whole-head MEG system designed specifically for pre-school aged children.

• The challenge in designing the CI MEG system was to distinguish brain signals from larger signals emitted by the CI

Seek / Invest in World-Unique Ideas


Brain Activation for Tonal Languages Identify International Partners


Focus on Connectivity & Ease of Use

“Made for iPhone” hearing aid accessories

Apple – US Patent application on February 7th for a system that will automatically detect a hearing aid and incorporating switching modes

The dominant device for people with mild and moderate loss (the most numerous segment) will be a combined hearing aid and hands-free device for their mobile phones, tablet devices, GPS, and other wi-fi enabled devices

Anticipate/Scan for Trends

“The reality is that direct-to-consumer hearing instrument sales are not going away - Audiology Today February 2013

Increasingly, professionals will need to seek market differentiation from direct-to-consumer web sites or insurance/pharmacy companies.


The Future Evolution A framework to build on

2014 2019

Sourcing revenue

Maintaining and building new relationships

55

CRC Extension

A radical change to Hearing Healthcare: hearing disorder hearing disability management clinician user-centric management central services services where users are

Transition Plan

translating innovation in hearing loss prevention and improved remediation to improved patient...

Health & Medicine

hearing technology

sound valuetm barriers

hearing loss prevention

sound valuetm source

sound valuetm age

years hearing loss

disabling hearing loss

cognitive decline hearing