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Cost-Effectiveness of Neonatal Hearing Screening Programs: A Micro-Simulation Modeling Analysis
Mirjam L Verkleij1, Eveline A M Heijnsdijk1, Andrea M L Bussé2,3
1Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Insights
Implementing a two-stage otoacoustic emissions (OAE) followed by automated auditory brainstem response (aABR) neonatal hearing screening is cost-effective for Albania. This protocol balances early detection of hearing impairment with financial feasibility.
Area of Science:
- Public Health
- Health Economics
- Audiology
Background:
- Early detection of neonatal hearing impairment is crucial for speech and language development.
- Universal neonatal hearing screening protocols vary significantly in implementation.
- Albania sought to determine the most cost-effective screening approach.
Purpose of the Study:
- To estimate the cost-effectiveness of various neonatal hearing screening protocols for Albania.
- To inform the implementation of a national neonatal hearing screening program.
Main Methods:
- A micro-simulation model was developed incorporating demographic data, disease natural history, and screening/treatment characteristics.
- Multiple protocols using otoacoustic emissions (OAE) and automated auditory brainstem response (aABR) were simulated.
- Cost-effectiveness was analyzed over a lifetime horizon.
Main Results:
- The two-stage OAE-aABR protocol in maternity wards and single-stage aABR were identified as the best protocols.
- The two-stage OAE-aABR protocol had an incremental cost-effectiveness ratio of €4181 per quality-adjusted life-year gained.
- Single-stage aABR detected more cases but incurred higher diagnostic costs due to increased referrals.
Conclusions:
- Only the two-stage OAE-aABR protocol fell below Albania's willingness-to-pay threshold (€10,413) and was deemed cost-effective.
- This study provides a comprehensive lifetime cost-effectiveness analysis of multiple neonatal hearing screening scenarios.
Objectives:
Early detection of neonatal hearing impairment moderates the negative effects on speech and language development. Universal neonatal hearing screening protocols vary in tests used, timing of testing and the number of stages of screening. This study estimated the cost-effectiveness of various protocols in the preparation of implementation of neonatal hearing screening in Albania.
Design:
A micro-simulation model was developed using input on demography, natural history of neonatal hearing impairment, screening characteristics and treatment. Parameter values were derived from a review of the literature and expert opinion. We simulated multiple protocols using otoacoustic emissions (OAE) and automated auditory brainstem response (aABR), varying the test type, timing and number of stages. Cost-effectiveness was analyzed over a life-time horizon.
Results:
The two best protocols for well infants were OAE followed by aABR (i.e., two-stage OAE-aABR) testing in the maternity ward and single-aABR testing. Incremental cost-effectiveness ratios were €4181 and €78,077 per quality-adjusted life-year gained, respectively. Single-aABR screening led to more cases being detected compared to a two-stage screening program. However, it also resulted in higher referral rates, which increased the total costs of diagnostics. Multi-staged screening decreased referral rates but may increase the number of missed cases due to false-negative test results and nonattendance.
Conclusions:
Only the 2-stage OAE-aABR (maternity ward) protocol was below the willingness-to-pay threshold of €10,413 for Albania, as suggested by the World Health Organization, and was found to be cost-effective. This study is among the few to assess neonatal hearing screening programs over a life-time horizon and the first to predict the cost-effectiveness of multiple screening scenarios.
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