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.
DESIGNCost 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).
SETTINGThe
Netherlands
TARGET POPULATIONAll
newborn infants not admitted to neonatal intensive care units.
MAIN OUTCOME
MEASURECosts per child detected with a hearing
loss of 40 dB or more in the better ear.
RESULTSCosts 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.
CONCLUSIONSThree
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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