Costs of different strategies for neonatal hearing screening: a modelling approach.
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.
Boshuizen
H C
HC
TNO Prevention and Health, Division of Public Health, Leiden, The Netherlands. Hendrick.Boshuizen@RIVM.NL
van der Lem
G J
GJ
Kauffman-de Boer
M A
MA
van Zanten
G A
GA
Oudesluys-Murphy
A M
AM
Verkerk
P H
PH
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