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Neonatal hearing screening: modelling cost and effectiveness of hospital- and community-based screening
Eva Grill1, Kai Uus, Franz Hessel
1Department of Physical Medicine and Rehabilitation, University of Munich, Germany. eva.grill@med.uni-muenchen.de
Insights
Universal newborn hearing screening in England showed similar effectiveness (794 quality-weighted detected child months) for both hospital and community programs. Cost-effectiveness varied based on program parameters and prevalence.
Area of Science:
- Public Health
- Health Economics
- Pediatrics
Background:
- Congenital hearing impairment necessitates early detection and management in children.
- Universal newborn hearing screening (NHSP) was implemented in England in 2001.
- This study evaluates the initial phase of the NHSP.
Purpose of the Study:
- To assess the costs and effectiveness of hospital-based versus community-based newborn hearing screening systems in England.
- To analyze the impact of parameter variations on cost-effectiveness.
Main Methods:
- Clinical effectiveness analysis utilizing a Markov Model.
- Outcome measure: quality-weighted detected child months (QCM).
Main Results:
- Both hospital and community programs achieved 794 QCM at 6 months.
- Total costs were £3,690,000 (hospital) and £3,340,000 (community) per 100,000 screened children.
- Hospital costs were simulated to be lower in 48% of trials.
Conclusions:
- Modeling provides quantitative projections for decision-makers, highlighting assumptions and uncertainty.
- Cost-effectiveness is sensitive to differences in prevalence, test sensitivity, and specificity.
- Future evaluations should focus on parameter and prevalence variations between settings.
Background:
Children with congenital hearing impairment benefit from early detection and management of their hearing loss. These and related considerations led to the recommendation of universal newborn hearing screening. In 2001 the first phase of a national Newborn Hearing Screening Programme (NHSP) was implemented in England. Objective of this study was to assess costs and effectiveness for hospital and community-based newborn hearing screening systems in England based on data from this first phase with regard to the effects of alterations to parameter values.
Design:
Clinical effectiveness analysis using a Markov Model.
Outcome Measure:
quality weighted detected child months (QCM).
Results:
Both hospital and community programmes yielded 794 QCM at the age of 6 months with total costs of 3,690,000 pound sterling per 100,000 screened children in hospital and 3,340,000 pound sterling in community. Simulated costs would be lower in hospital in 48% of the trials. Any statistically significant difference between hospital and community in prevalence, test sensitivity, test specificity and costs would result in significant differences in cost-effectiveness between hospital and community.
Conclusion:
This modelling exercise informs decision makers by a quantitative projection of available data and the explicit and transparent statements about assumptions and the degree of uncertainty. Further evaluation of the cost-effectiveness should focus on the potential differences in test parameters and prevalence in these two settings.
