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Costs of different strategies for neonatal hearing screening: a modelling approach
H C Boshuizen1, G J van der Lem, M A Kauffman-de Boer
1TNO Prevention and Health, Division of Public Health, Leiden, The Netherlands. Hendrick.Boshuizen@RIVM.NL
Insights
A three-stage neonatal hearing screening using otoacoustic emissions is the most cost-effective strategy. This approach detects hearing loss in newborns more efficiently than other methods.
Area of Science:
- Neonatal care
- Public health
- Audiology
Background:
- Early detection of hearing loss in newborns is crucial for developmental outcomes.
- Various screening methods and process designs exist, each with different cost implications.
Purpose of the Study:
- To compare the cost-effectiveness of different neonatal hearing screening strategies.
- To estimate the cost per hearing-impaired child detected by each strategy.
Main Methods:
- Cost analysis using a simulation model with multivariate sensitivity analysis.
- Comparison of screening methods (automated auditory brainstem response vs. otoacoustic emissions).
- Evaluation of two- vs. three-stage screening processes, and bilateral vs. unilateral hearing loss detection.
Main Results:
- A three-stage screening process using otoacoustic emissions in child health clinics costs £25.0 per child detected.
- This is more cost-effective than automated auditory brainstem response (£39.0).
- Detecting unilateral hearing loss adds £1500-£4000 per child.
Conclusions:
- A three-stage screening process employing otoacoustic emissions is recommended for neonatal hearing screening.
- Further research is needed to determine the optimal screening location (home vs. clinic).
Objective:
To compare the cost effectiveness of various strategies for neonatal hearing screening by estimating the cost per hearing impaired child detected.
Design:
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).
Setting:
The Netherlands
Target Population:
All newborn infants not admitted to neonatal intensive care units.
Main Outcome Measure:
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.