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 developme nt of portable automated devices. Universal screening is a 2-stage screenin g process using automated transient-evoked otoacoustic emissions, followed when indicated by automated auditory brain response testing. Targeted scree ning reserves the 2-stage screening process for those infants at risk for c ongenital hearing loss. Objective: To compare the expected costs and benefits of targeted screening with universal screening for the detection of significant bilateral congen ital hearing loss. Design: Cost-effectiveness analysis from the health care system perspective , including costs directly related to screening and initial follow-up evalu ation. Main Outcome Measures: Number of cases identified, number of false positive s, and cost per case. Results: For every 100 000 newborns screened, universal screening detects 8 6 of 110 cases of congenital hearing loss, at a cost of $11 650 per case id entified. Targeted screening identifies 51 of 110 cases, at S3120 per case identified. Universal screening produces 320 false-positive results, 304 mo re 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 l oss, at the expense of both greater cost and more false-positive screening results. Little is known about the negative impact of false-positive screen ing and about the benefits of early intervention for congenital hearing los s. Those who advocate adoption of universal screening should be aware not o nly of the direct costs of universal screening, but of the indirect costs a nd strategies to increase the benefits of screening.