Comparison of costs and referral rates of 3 universal newborn hearing screening protocols.
OBJECTIVE
To investigate the costs and referral rates of 3 universal newborn hearing screening programs: transient evoked otoacoustic emissions (TEOAE), automated auditory brainstem response (AABR), and a combination, two-step protocol in which TEOAE and AABR are used.


METHODS
Clinical outcomes (referral rates) from 12,081 newborns at 5 sites were obtained by retrospective analysis. Prospective activity-based costing techniques (n = 1056) in conjunction with cost assumptions were used to analyze the costs based on an assumed annual birth rate of 1500 births.


RESULTS
Referral rates differed significantly among the 3 screening protocols (AABR, 3.21%; two-step, 4.67%; TEOAE, 6.49%; P <.01), with AABR achieving the best referral rate at discharge. Although AABR had the lowest referral rate at discharge and the highest pre-discharge costs, the total pre- and post-discharge costs per infant screened (AABR, $32.81; two-step, $33.05; TEOAE, $28.69) and costs per identified child (AABR, $16,405; two-step, $16,527; TEOAE, $14,347) were similar among programs.


CONCLUSIONS
Although AABR incurs higher costs during pre-discharge screening, it has lower referral rates than either the TEOAE or two-step program. As a result, the total costs of newborn hearing screening and diagnosis are similar among the 3 methods studied.
Vohr
B R
BR
Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island 02905-2499, USA.
Oh
W
W
Stewart
E J
EJ
Bentkover
J D
JD
Gabbard
S
S
Lemons
J
J
Papile
L A
LA
Pye
R
R
D003365:Costs and Cost Analysis; D016057:Evoked Potentials, Auditory, Brain Stem; D006320:Hearing Tests / Q000191:economics* / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening / Q000191:economics*; D015337:Multicenter Studies as Topic; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity