A cost-effectiveness analysis of the high risk register and auditory brainstem response

To evaluate an infant hearing screening program utilizing the high risk register (HRR) and auditory brainstem response (ABR).

A cost-effectiveness analysis of the screening program employing a retrospective cohort identified by chart review. The analysis was performed on a hypothetical cohort of 100,000 births and the results compared with a base model derived from literature review.

Mount Sinai Hospital, New York City, an urban, tertiary care institution.

All infants born between November 1990 and October 1993, approximately 16,500. Cost-effectiveness analysis focused on test results of 420 infants failing the HRR and 381 who subsequently received ABR.

Analysis of the Mount Sinai Hospital (MSH) protocol showed it to be less cost-effective than other similar programs. The cost per hearing loss was far more at MSH than that found elsewhere. Further, the MSH program was ineffective in detecting infants with congenital hearing loss--identifying only one case between 1990 and 1993. Analysis of high risk criteria finds a low incidence of family history of hearing loss in the Mount Sinai cohort while other studies find a very high incidence.

It appears that the poor performance of the MSH protocol is due to low specificity and sensitivity of the HRR. This generates a costly and ineffective program as follow-up exams focus on ruling-out false-positives rather than correctly identifying true hearing losses. Further evaluation is needed to determine whether changes in the application of the HRR or utilization of newer, low-cost tests such as otoacoustic emissions (OAE) may be effective in universal infant hearing screening.