A cost-effectiveness analysis of newborn hearing screening strategies

Context: Congenital hearing loss affects between 1 and 3 out of every 1000 children. Screening of all neonates has been made possible by the development of portable automated devices. Universal screening is a 2-stage screening process using automated transient-evoked otoacoustic emissions, followed when indicated by automated auditory brain response testing. Targeted screening reserves the 2-stage screening process for those infants at risk for congenital hearing loss. Objective: To compare the expected costs and benefits of targeted screening with universal screening for the detection of significant bilateral congenital hearing loss. Design: Cost-effectiveness analysis from the health care system perspective, including costs directly related to screening and initial follow-up evaluation. Main Outcome Measures: Number of cases identified, number of false positives, and cost per case. Results: For every 100 000 newborns screened, universal screening detects 86 of 110 cases of congenital hearing loss, at a cost of $11 650 per case identified. Targeted screening identifies 51 of 110 cases, at S3120 per case identified. Universal screening produces 320 false-positive results, 304 more than targeted screening. Switching to universal screening from targeted screening would cost an additional S23 930 for each extra case detected. Conclusions: Universal screening detects more cases of congenital hearing loss, at the expense of both greater cost and more false-positive screening results. Little is known about the negative impact of false-positive screening and about the benefits of early intervention for congenital hearing loss. Those who advocate adoption of universal screening should be aware not only of the direct costs of universal screening, but of the indirect costs and strategies to increase the benefits of screening.