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Newborn hearing screening: costs of establishing a program
James Lemons1, Avroy Fanaroff, Edward J Stewart
1Section of Neonatal-Perinatal Medicine, Riley Hospital for Children, Indianapolis, IN 46202-5119, USA.
Summary
Automated auditory brainstem response (AABR) is the preferred method for universal newborn hearing screening, offering lower costs and faster achievement of low referral rates compared to transient evoked otoacoustic emissions (TEOAE).
Area of Science:
- Audiology
- Neonatal Care
- Health Economics
Background:
- Universal Newborn Hearing Screening (UNHS) programs are crucial for early detection of hearing loss in infants.
- Two common screening methods are Automated Auditory Brainstem Response (AABR) and Transient Evoked Otoacoustic Emissions (TEOAE).
- Evaluating the economic and performance aspects of UNHS start-up phases is essential for efficient program implementation.
Purpose of the Study:
- To compare the costs and performance characteristics of the initial phase of UNHS programs using AABR versus TEOAE.
- To determine the efficiency and effectiveness of AABR and TEOAE in the early stages of implementation.
Main Methods:
- Economic and performance data were collected during the initiation of AABR and TEOAE screening programs.
- Data collection continued until 1500 infants were screened or a referral rate of ≤5% at hospital discharge was achieved.
- Key metrics included screening pass/fail rates, referral rates, and utilization of personnel, equipment, and supplies, using actual costs.
Main Results:
- The AABR program, utilizing neonatal nurses, screened infants faster (average age 9.5 hours) and achieved higher screening rates within 24 hours (84%) compared to the TEOAE program (average age 29 hours, 35%).
- The AABR program achieved significantly lower referral rates at hospital discharge (starting at 8% and decreasing to <4%) compared to the TEOAE program (consistently ~15%).
- Total costs per infant screened, including post-discharge evaluations, were lower for AABR (US$45.85) than for TEOAE (US$58.07).
Conclusions:
- Automated Auditory Brainstem Response (AABR) is the recommended method for universal newborn hearing screening.
- AABR demonstrated lower overall costs, achieved superior referral rate reduction, and exhibited a quicker learning curve for program establishment.
- The findings support AABR as a more efficient and cost-effective approach for initiating UNHS programs.