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

M Oudesluys-Murphy, P H Verkerk Objective—To compare the cost eVective-ness 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 bilat-eral 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 otoa-coustic 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 infor-mation, 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 eVective than screening at a child health clinic needs further study