title: Costs of different strategies for neonatal hearing screening: a modelling approach.
abstract: OBJECTIVE
  To compare the cost effectiveness of various strategies for neonatal hearing screening by estimating the cost per hearing impaired child detected.
  
  
  METHODS
  Cost analyses with a simulation model, including a multivariate sensitivity analysis. Comparisons of the cost per child detected were made for: screening method (automated auditory brainstem response or otoacoustic emissions); number of stages in the screening process (two or three); target disorder (bilateral hearing loss or both unilateral and bilateral loss); location (at home or at a child health clinic).
  
  
  METHODS
  The Netherlands
  
  
  METHODS
  All newborn infants not admitted to neonatal intensive care units.
  
  
  METHODS
  Costs per child detected with a hearing loss of 40 dB or more in the better ear.
  
  
  RESULTS
  Costs of a three stage screening process in child health clinics are 39.0 pounds (95% confidence interval 20.0 to 57.0) per child detected with automated auditory brainstem response compared with 25.0 (14.4 to 35.6) pounds per child detected with otoacoustic emissions. A three stage screening process not only reduces the referral rates, but is also likely to cost less than a two stage process because of the lower cost of diagnostic facilities. The extra cost (over and above a screening programme detecting bilateral losses) of detecting one child with unilateral hearing loss is 1500-4000 pounds. With the currently available information, no preference can be expressed for a screening location.
  
  
  CONCLUSIONS
  Three stage screening with otoacoustic emissions is recommended. Whether screening at home is more cost effective than screening at a child health clinic needs further study.
authors.affiliation: TNO Prevention and Health, Division of Public Health, Leiden, The Netherlands. Hendrick.Boshuizen@RIVM.NL
authors.forename: H C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: G J
authors.initials: GJ
authors.lastname: van der Lem
authors.forename: M A
authors.initials: MA
authors.lastname: Kauffman-de Boer
authors.forename: G A
authors.initials: GA
authors.lastname: van Zanten
authors.forename: A M
authors.initials: AM
authors.lastname: Oudesluys-Murphy
authors.forename: P H
authors.initials: PH
authors.lastname: Verkerk
mesh_terms: D001300:Audiometry, Evoked Response / Q000191:economics; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D003638:Deafness / Q000175:diagnosis* / Q000191:economics; D004209:Disposable Equipment / Q000191:economics; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018803:Models, Economic; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D015997:Neonatal Screening / Q000191:economics* / Q000379:methods; D017084:Otoacoustic Emissions, Spontaneous; D011237:Predictive Value of Tests