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Arch Dis Child Fetal Neonatal Ed 2001;85:F177-F181 ( November )

Costs of different strategies for neonatal hearing screening: a modelling approach

H C Boshuizena, G J van der Lemb, M A Kauffman-de Boerb, G A van Zantenc, A M Oudesluys-Murphyd, P H Verkerke

a TNO Prevention and Health, Division of Public Health, Leiden, The Netherlands, b Dutch foundation of the Deaf and Hard of Hearing Child, c Department of Audiology, Academic Hospital Rotterdam/Sophia Children Hospital/Erasmus University Rotterdam, Rotterdam, The Netherlands, d Department of Paediatrics, Medical Center Rijnmond-Zuid, Location Zuider, Rotterdam, e TNO Prevention and Health, Division of Child Health and Health Care, Leiden

Correspondence to: Dr Boshuizen, National Institute of Public Health and the Environment, Computerisation and Methodological Consultancy Unit, PO Box 1, NL-3720 BA Bilthoven, The Netherlands Hendriek.Boshuizen{at}RIVM.NL

Accepted 6 July 2001

OBJECTIVE---To compare the cost effectiveness of various strategies for neonatal hearing screening by estimating the cost per hearing impaired child detected.
DESIGN---Cost analyses with a simulation model, including a multivariate sensitivity analysis. Comparisons of the cost per child detected were made for: screening method (automated auditory brainstem response or otoacoustic emissions); number of stages in the screening process (two or three); target disorder (bilateral hearing loss or both unilateral and bilateral loss); location (at home or at a child health clinic).
SETTING---The Netherlands
TARGET POPULATION---All newborn infants not admitted to neonatal intensive care units.
MAIN OUTCOME MEASURE---Costs per child detected with a hearing loss of 40 dB or more in the better ear.
RESULTS---Costs of a three stage screening process in child health clinics are 39.0 (95% confidence interval 20.0 to 57.0) per child detected with automated auditory brainstem response compared with 25.0 (14.4 to 35.6) per child detected with otoacoustic emissions. A three stage screening process not only reduces the referral rates, but is also likely to cost less than a two stage process because of the lower cost of diagnostic facilities. The extra cost (over and above a screening programme detecting bilateral losses) of detecting one child with unilateral hearing loss is 1500-4000. With the currently available information, no preference can be expressed for a screening location.
CONCLUSIONS---Three stage screening with otoacoustic emissions is recommended. Whether screening at home is more cost effective than screening at a child health clinic needs further study.


Keywords: costs; hearing; screening; otoacoustic emissions; automated auditory brainstem response

© 2001 by Archives of Disease in Childhood




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