Hearing loss screening in the neonatal intensive care unit: auditory brain stem response versus Crib-O-Gram; a...

We used cost-effectiveness analysis to compare two strategies for screening for severe hearing loss in the neonatal intensive care unit (NICU): the auditory brain stem response (ABR) and the Crib-O-Gram (COG). We studied hypothetical cohorts of infants using data derived from the literature on screening test characteristics. We included the costs of initial screening and those of further diagnostic testing for infants who fail the screening test. The ABR cost more per test administered than COG, but had higher sensitivity and specificity to detect hearing loss. We found the ABR, therefore, to be more cost effective than the COG. Using best-estimate assumptions, ABR cost $10,610 for each correctly detected case of hearing loss; COG cost $14,310 for each correctly detected case; among every 1,000 NICU infants screened, furthermore, ABR detected all cases of hearing loss, whereas COG failed to detect five hearing-impaired infants. We conclude that cost-effectiveness analysis justifies using ABR as a screening tool.