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The costs of early hearing screening in England and Wales
J C Stevens1, D M Hall, A Davis
1Department of Medical Physics and Clinical Engineering, Royal Hallamshire Hospital, Sheffield.
Insights
Universal neonatal screening (UNS) for infant hearing loss is more cost-effective than the health visitor distraction test (HVDT). Targeted neonatal screening (TNS) also offers an inexpensive way to identify congenital hearing impairment.
Area of Science:
- Health economics
- Public health
- Audiology
Background:
- Early identification of hearing loss in infants is crucial for developmental outcomes.
- Various hearing screening methods exist, each with different cost implications.
- Understanding the cost-effectiveness of different screening programs is essential for resource allocation.
Purpose of the Study:
- To determine the costs associated with different infant hearing screening methods in England and Wales.
- To compare the cost-effectiveness of targeted neonatal screening (TNS), universal neonatal screening (UNS), and the health visitor distraction test (HVDT).
Main Methods:
- A survey was conducted across 10 centers in England and Wales.
- Data on service costs were collected for TNS, UNS, and HVDT.
- Costs were standardized for a district of 1000 live births at 1994 prices.
Main Results:
- Neonatal screening costs were consistent across centers, while HVDT costs varied significantly.
- Mean service costs per 1000 live births were: TNS - £5,052, UNS - £13,881, HVDT - £24,519.
- Follow-up cost data were available for only five HVDT screens.
Conclusions:
- Universal neonatal screening (UNS) is not prohibitively expensive and is less costly than HVDT screening.
- Targeted neonatal screening (TNS) is a cost-effective method for identifying some congenital hearing impairments early.
- UNS, with complementary systems for late-onset hearing loss, appears to be the most cost-effective overall approach.
Abstract:
A survey was carried out in 10 centres in England and Wales to determine the costs of hearing screening in the first year of life. The screens that were studied were targeted neonatal, universal neonatal, and the health visitor distraction test (HVDT) or alternative surveillance. Valid data were available from five centres for targeted neonatal screening (TNS), three for universal neonatal screening (UNS), and nine for the HVDT, although only five of the HVDT screens had valid data for follow up costs. The neonatal costs were consistent across the centres surveyed, whereas those for the HVDT screen varied considerably. The mean service costs for TNS, UNS, and the HVDT at 1994 prices were 5052 Pounds, 13,881 Pounds, and 24,519 Pounds for a standardised district of 1000 live births. Three conclusions seem justified. Firstly, UNS need not be prohibitively expensive as it costs considerably less than HVDT screening. Secondly, TNS appears to be a relatively inexpensive way of improving the age of identification of a proportion of the congenitally hearing impaired. Thirdly, given the published yields for UNS and the HVDT, the results indicate that UNS offers the most cost effective overall approach with alternative systems in place to identify late onset permanent hearing losses.