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Cost-effectiveness of portable-automated ABR for universal neonatal hearing screening in India
Krushna Chandra Sahoo1, Rinshu Dwivedi1, Ramesh Athe1
1Health Technology Assessment in India (HTAIn), Regional Resource Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
Insights
Portable Automated Auditory Brainstem Responses (P-AABR) offer a cost-effective solution for Universal Neonatal Hearing Screening (UNHS) in India. This technology improves diagnostic accuracy and detects more hearing-impaired infants, addressing program shortages.
Area of Science:
- Public Health
- Audiology
- Health Economics
Background:
- Universal Neonatal Hearing Screening (UNHS) is crucial for global public health.
- India's Rashtriya Bal Swasthya Karyakram (RBSK) program faces challenges with human resources, infrastructure, and equipment for newborn hearing screening.
- There is a need for first-line hearing screening methods with enhanced diagnostic accuracy.
Purpose of the Study:
- To evaluate the cost-effectiveness of Portable Automated Auditory Brainstem Responses (P-AABR) for UNHS.
- To compare the cost-effectiveness of P-AABR with Otoacoustic Emission (OAE) screening.
- To assess the feasibility and safety of P-AABR for UNHS in resource-limited settings.
Main Methods:
- An analytical decision tree model was used to assess cost-effectiveness.
- The study compared P-AABR and OAE screening methods.
- Costs and detection rates for both screening methods were analyzed.
Main Results:
- P-AABR screening resulted in a total health system cost of INR 10,535,915 and detected 262 cases.
- OAE screening cost INR 7,256,198 and detected 26 cases.
- The cost per case detection was INR 97 for P-AABR and INR 67 for OAE, with a final Incremental Cost-Effectiveness Ratio (ICER) of 97407.69.
Conclusions:
- P-AABR is a cost-effective, safe, and feasible technology for UNHS within RBSK programs.
- P-AABR enhances the detection of hearing-impaired infants and reduces false referrals.
- Integrating P-AABR into community and primary health centers can expand UNHS coverage, even with workforce shortages.
Abstract:
The World Health Organization considers Universal Neonatal Hearing Screening (UNHS) essential to global public health. Rashtriya Bal Swasthya Karyakram has included newborn hearing screening in India since 2013. The program faces human, infrastructure, and equipment shortages. First-line hearing screening with improved diagnostic accuracy is needed. The Portable Automated Auditory Brainstem Responses (P-AABR) can be used in remote areas for UNHS due to its low infrastructure needs and diagnostic accuracy. This study evaluated the cost-effectiveness of P-AABR in UNHS. We employed an analytical model based on decision trees to assess the cost-effectiveness of Otoacoustic Emission (OAE) and P-AABR. The total cost to the health system for P-AABR, regardless of true positive cases, is INR 10,535,915, while OAE costs INR 7,256,198. P-AABR detects 262 cases, whereas OAE detects 26 cases. Portable Automated ABR costs INR 97 per case detection, while OAE costs INR 67. The final ICER was 97407.69. The P-AABR device is cost-effective, safe and feasible for UNHS Rashtriya Bal Swasthya Karyakram (RBSK) programs. Beyond reducing false referrals and parent indirect costs, it detects more hearing-impaired infants. Even in shortages of skilled workers, existing staff can be trained. Thus, this study suggests integrating this device into community and primary health centers to expand UNHS coverage.
