Comparison of costs and referral rates of 3 universal newborn hearing screening protocols

Objective: To investigate the costs and referral rates of 3 universal newbo rn hearing screening programs: transient evoked otoacoustic emissions (TEOA E), automated auditory brainstem response (AABR), and a combination, two-st ep protocol in which TEOAE and AABR are used. Study design: Clinical outcomes (referral rates) from 12,081 newborns at 5 sites were obtained by retrospective analysis. Prospective activity-based c osting techniques (n = 1056) in conjunction with cost assumptions were used to analyze the costs based on an assumed annual birth rate of 1500 births. Results: Referral rates differed significantly among the 3 screening protoc ols (AABR, 3.21%; two-step, 4.67%; TEOAE, 6.49%; P <.01), with AABR achievi ng the best referral rate at discharge. Although AABR had the lowest referr al rate at discharge and the highest pre-discharge costs, the total pre- an d post-discharge costs per infant screened (AABR, $32.81; two-step, $33.05; TEOAE, $28.69) and costs per identified child (AABR, $16,405; two-step, $1 6,527; TEOAE, $14,347) were similar among programs. Conclusion: Although AABR incurs higher costs during pre-discharge screenin g, it has lower referral rates than either the TEOAE or two-step program. A s a result, the total costs of newborn hearing screening and diagnosis are similar among the 3 methods studied.