Related Experiment Videos
A cost-effectiveness analysis of newborn hearing screening strategies
1Children's Primary Care Research Group, Department of Pediatrics University of North Carolina, Chapel Hill 27599-7225, USA. akemper@med.unc.edu
Insights
Universal screening for congenital hearing loss detects more cases but incurs higher costs and more false positives compared to targeted screening. Further research is needed on the impact of false positives and benefits of early intervention.
Area of Science:
- Neonatal care
- Public health screening programs
- Audiology
Background:
- Congenital hearing loss impacts 1-3 per 1,000 newborns.
- Automated devices enable universal newborn screening.
- Screening involves otoacoustic emissions and auditory brain response tests.
Purpose of the Study:
- Compare costs and benefits of universal vs. targeted congenital hearing loss screening.
- Evaluate detection rates and cost-effectiveness.
Main Methods:
- Cost-effectiveness analysis from a healthcare system perspective.
- Included direct screening and initial follow-up costs.
- Evaluated cases identified, false positives, and cost per case.
Main Results:
- Universal screening identified 86/110 cases at $11,650/case; targeted identified 51/110 cases at $3,120/case.
- Universal screening yielded 320 false positives, 304 more than targeted.
- Switching to universal screening costs an additional $23,930 per extra case detected.
Conclusions:
- Universal screening detects more hearing loss cases but increases costs and false positives.
- Impacts of false positives and benefits of early intervention require further study.
- Adoption of universal screening necessitates awareness of direct and indirect costs and benefit maximization strategies.
Context:
Congenital hearing loss affects between 1 and 3 out of every 1,000 children. Screening of all neonates has been made possible by the development of portable automated devices. Universal screening is a 2-stage screening process using automated transient-evoked otoacoustic emissions, followed when indicated by automated auditory brain response testing. Targeted screening reserves the 2-stage screening process for those infants at risk for congenital hearing loss.
Objective:
To compare the expected costs and benefits of targeted screening with universal screening for the detection of significant bilateral congenital hearing loss.
Design:
Cost-effectiveness analysis from the health care system perspective. including costs directly related to screening and initial follow-up evaluation.
Main Outcome Measures:
Number of cases identified, number of false positives, and cost per case.
Results:
For every 100,000 newborns screened, universal screening detects 86 of 110 cases of congenital hearing loss, at a cost of $11,650 per case identified. Targeted screening identifies 51 of 110 cases, at $3,120 per case identified. Universal screening produces 320 false-positive results, 304 more than targeted screening. Switching to universal screening from targeted screening would cost an additional $23, 930 for each extra case detected.
Conclusions:
Universal screening detects more cases of congenital hearing loss, at the expense of both greater cost and more false-positive screening results. Little is known about the negative impact of false-positive screening and about the benefits of early intervention for congenital hearing loss. Those who advocate adoption of universal screening should be aware not only of the direct costs of universal screening, but of the indirect costs and strategies to increase the benefits of screening.