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Infant Auditory Processing and Event-related Brain Oscillations
Published on: July 1, 2015
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.
Insights
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.
Objective:
To evaluate the costs and performance characteristics associated with the start-up phase of Universal Newborn Hearing Screening Programs, one utilizing automated auditory brainstem response (AABR) and the other using transient evoked otoacoustic emissions (TEOAE).
Study Design:
Economic and performance data were collected at the initiation of both screening programs. Data were collected until 1500 newborn infants were screened or until a referral rate for further audiologic evaluation at hospital discharge of less than or equal to 5% was achieved. Data collected included screening pass/fail rates, referral rates and personnel, equipment, and supply utilization. Actual costs of personnel, equipment, and supplies were used. Statistical comparisons of proportions using z-statistic with the one-tailed test and an alpha of 0.01 were made.
Results:
Screening in the AABR program was performed by neonatal nurses, whereas screening in the TEOAE program was performed by master's level audiologists. The average age at initial screen was 29 hours for TEOAE, and 9.5 hours for AABR. Eighty-four percent of infants was screened within 24 hours in the AABR program, in contrast to 35% in the TEOAE program. Throughout the duration of the study, the referral rate at hospital discharge remained approximately 15% for the TEOAE program. The AABR referral rate began at 8% and was less than 4% at the completion of the study. Pre-discharge total costs for initiating and establishing the programs were US$49,316 for TEOAE and US$47,553 for AABR. Cost per infant screened was US$32.23 and US$33.68, respectively. When post-discharge screening and diagnostic evaluation costs were included, the total cost per infant screened was US$58.07 for TEOAE and US$45.85 for AABR.
Conclusion:
AABR appears to be the preferred method for universal newborn hearing screening. AABR was associated with the lowest costs, achieved the lowest referral rates at hospital discharge, and had the quickest learning curve to achieve those rates.
