A cost-effectiveness analysis of newborn hearing screening strategies

Alex R. Kemper, Stephen Downs

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

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 $3120 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 $23 930 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.

Original languageEnglish (US)
Pages (from-to)484-488
Number of pages5
JournalArchives of Pediatrics and Adolescent Medicine
Volume154
Issue number5
StatePublished - May 2000
Externally publishedYes

Fingerprint

Hearing
Cost-Benefit Analysis
Newborn Infant
Hearing Loss
Costs and Cost Analysis
Bilateral Hearing Loss
Outcome Assessment (Health Care)
Delivery of Health Care
Equipment and Supplies
Brain

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

A cost-effectiveness analysis of newborn hearing screening strategies. / Kemper, Alex R.; Downs, Stephen.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 154, No. 5, 05.2000, p. 484-488.

Research output: Contribution to journalArticle

@article{86657516ff8046418c48a0c65f89de58,
title = "A cost-effectiveness analysis of newborn hearing screening strategies",
abstract = "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 $3120 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 $23 930 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.",
author = "Kemper, {Alex R.} and Stephen Downs",
year = "2000",
month = "5",
language = "English (US)",
volume = "154",
pages = "484--488",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "5",

}

TY - JOUR

T1 - A cost-effectiveness analysis of newborn hearing screening strategies

AU - Kemper, Alex R.

AU - Downs, Stephen

PY - 2000/5

Y1 - 2000/5

N2 - 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 $3120 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 $23 930 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.

AB - 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 $3120 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 $23 930 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.

UR - http://www.scopus.com/inward/record.url?scp=0034023347&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034023347&partnerID=8YFLogxK

M3 - Article

VL - 154

SP - 484

EP - 488

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 5

ER -