Optimizing Decision Making in Universal Newborn Hearing Screening: A Value of Information Perspective

Area of Science:

• Health economics
• Public health policy
• Decision analysis

Background:

• Uncertainty exists regarding the cost-effectiveness of Australia's universal newborn hearing screening (UNHS) program.
• Value of information (VOI) analysis is a framework to assess the need for further research.
• Recent advancements have made VOI analysis more feasible for decision-making.

Purpose of the Study:

• To quantify the value of additional research for Australia's UNHS program.
• To guide future research priorities by estimating the value of evidence.
• To determine the sample size needed to maximize the value of information for decision-making.

Main Methods:

• A decision-analytic model, including a decision tree and a Markov model with a 26-year time horizon, was developed.
• Cost-effectiveness of UNHS versus no screening was evaluated using Australian longitudinal studies and published data.
• Expected value of perfect information (EVPI), expected value of partial information (EVPI), and expected value of sample information (EVSI) were estimated.

Main Results:

• The incremental cost-effectiveness ratio (ICER) was $39,400 per quality-adjusted life-year (QALY), with a 50% probability of being cost-effective at the $40,900/QALY threshold.
• The EVPI for 2.5 million newborns over 10 years was $130.30 million.
• Utility values, particularly their association with diagnosis age, were the primary source of uncertainty, with EVSI suggesting 300-500 additional utility data points worth $106.41-$113.91 million.

Conclusions:

• Australia's UNHS program demonstrates cost-effectiveness below the threshold, despite some uncertainty.
• Collecting additional utility data is crucial for reducing decision uncertainty.
• Findings have implications for UNHS programs in Australia and globally.