title: Cost-effectiveness analysis of neonatal hearing screening program in China: should universal screening be prioritized?
abstract: BACKGROUND
  Neonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China.
  
  
  METHODS
  A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces.
  
  
  CONCLUSIONS
  A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both strategies especially universal strategy achieve a good economic effect in the long term costs.
  
  
  CONCLUSIONS
  Universal screening might be considered as the prioritized implementation goal especially in those relatively developed provinces of China as it provides the best health and economic effects, while targeted screening might be temporarily more realistic than universal screening in those relatively developing provinces of China.
authors.affiliation: Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Li-Hui
authors.initials: LH
authors.lastname: Huang
authors.forename: Luo
authors.initials: L
authors.lastname: Zhang
authors.forename: Ruo-Yan Gai
authors.initials: RY
authors.lastname: Tobe
authors.forename: Fang-Hua
authors.initials: FH
authors.lastname: Qi
authors.forename: Long
authors.initials: L
authors.lastname: Sun
authors.forename: Yue
authors.initials: Y
authors.lastname: Teng
authors.forename: Qing-Lin
authors.initials: QL
authors.lastname: Ke
authors.forename: Fei
authors.initials: F
authors.lastname: Mai
authors.forename: Xue-Feng
authors.initials: XF
authors.lastname: Zhang
authors.forename: Mei
authors.initials: M
authors.lastname: Zhang
authors.forename: Ru-Lan
authors.initials: RL
authors.lastname: Yang
authors.forename: Lin
authors.initials: L
authors.lastname: Tu
authors.forename: Hong-Hui
authors.initials: HH
authors.lastname: Li
authors.forename: Yan-Qing
authors.initials: YQ
authors.lastname: Gu
authors.forename: Sai-Nan
authors.initials: SN
authors.lastname: Xu
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Yue
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Li
authors.forename: Bei-Er
authors.initials: BE
authors.lastname: Qi
authors.forename: Xiao-Huan
authors.initials: XH
authors.lastname: Cheng
authors.forename: Wei
authors.initials: W
authors.lastname: Tang
authors.forename: Ling-Zhong
authors.initials: LZ
authors.lastname: Xu
authors.forename: De-Min
authors.initials: DM
authors.lastname: Han
mesh_terms: D002681:China; D017046:Cost Savings / Q000706:statistics & numerical data / Q000639:trends; D003362:Cost-Benefit Analysis / Q000639:trends; D016208:Databases, Factual; D004519:Education, Special / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics; D006311:Hearing Disorders / Q000175:diagnosis* / Q000628:therapy; D034381:Hearing Loss / Q000175:diagnosis* / Q000534:rehabilitation / Q000628:therapy; D006320:Hearing Tests / Q000191:economics* / Q000379:methods; D006771:Hospitals, Maternity; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015233:Models, Statistical; D009313:National Health Programs; D015997:Neonatal Screening / Q000191:economics*; D015397:Program Evaluation; D011788:Quality of Life; D019057:Quality-Adjusted Life Years