title: Comparison of costs and referral rates of 3 universal newborn hearing screening protocols.
abstract: 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.
authors.affiliation: Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island 02905-2499, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Vohr
authors.forename: W
authors.initials: W
authors.lastname: Oh
authors.forename: E J
authors.initials: EJ
authors.lastname: Stewart
authors.forename: J D
authors.initials: JD
authors.lastname: Bentkover
authors.forename: S
authors.initials: S
authors.lastname: Gabbard
authors.forename: J
authors.initials: J
authors.lastname: Lemons
authors.forename: L A
authors.initials: LA
authors.lastname: Papile
authors.forename: R
authors.initials: R
authors.lastname: Pye
mesh_terms: 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