Cost-Effectiveness of Neonatal Hearing Screening Programs: A Micro-Simulation Modeling Analysis.
Mirjam L Verkleij, Eveline A M Heijnsdijk, Andrea M L Bussé and 8 others
PMID 33306547WHAT IT FOUND
For Albania, a two-stage screening protocol (OAE then aABR, both in maternity) was the only cost-effective option under 3D GDP thresholds.
Adding stages or delaying tests lowered detection rates and increased costs. Clinicians should prioritize early, inpatient screening to maximize uptake.
Key findings
01The two-stage OAE-aABR (maternity) protocol was the only one that fell under the willingness-to-pay threshold for Albania.
02Multi-stage protocols performed after hospital discharge had lower participation rates (70%) compared to inpatient screening (95%), resulting in fewer detected cases.
03Performing the first screening test within 24 hours of birth increased the referral rate to 20% due to middle ear fluid, compared to 9.7% on day 2.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The model only included full-term, well babies; it excluded infants admitted to the neonatal intensive care unit, who have higher rates of hearing impairment and different screening needs. The analysis used a healthcare perspective only, excluding societal costs like parental travel time or lost income, which can be significant in rural areas. Key input parameters, such as the exact relationship between hearing loss severity and quality of life, were based on assumptions and limited data, particularly regarding the long-term benefits of early intervention. The results are specific to the Albanian healthcare system and cost structure; they may not directly apply to other countries with different infrastructure or willingness-to-pay thresholds. The model assumed that all eligible infants would receive hearing aids, despite noting that cochlear implantation opportunities are currently limited in Albania.
Declared interests
The authors declared no conflicts of interest. The study was part of the EUSCREEN project, which involved a large consortium of international partners, but no specific commercial funding or sponsorship influencing the results was disclosed.
The easy way to misread this
Do not apply these cost-effectiveness conclusions to your own country without adjustment. The finding that the two-stage maternity protocol is cost-effective is specific to Albania's healthcare costs and willingness-to-pay thresholds. In settings with different infrastructure, travel distances, or unit costs, the optimal protocol may vary significantly.