Neonatal hearing screening: modelling cost and effectiveness of hospital- and community-based screening

Abstract

Background: Children with congenital hearing impairment benefit from early detection and management of their hearing loss. These and related considerations led to the recommendation of universal newborn hearing screening. In 2001 the first phase of a national Newborn Hearing Screening Programme (NHSP) was implemented in England. Objective of this study was to assess costs and effectiveness for hospital and community-based newborn hearing screening systems in England based on data from this first phase with regard to the effects of alterations to parameter values.

Design: Clinical effectiveness analysis using a Markov Model.

Outcome measure: quality weighted detected child months (QCM).

Results: Both hospital and community programmes yielded 794 QCM at the age of 6 months with total costs of 3,690,000 pound sterling per 100,000 screened children in hospital and 3,340,000 pound sterling in community. Simulated costs would be lower in hospital in 48% of the trials. Any statistically significant difference between hospital and community in prevalence, test sensitivity, test specificity and costs would result in significant differences in cost-effectiveness between hospital and community.

Conclusion: This modelling exercise informs decision makers by a quantitative projection of available data and the explicit and transparent statements about assumptions and the degree of uncertainty. Further evaluation of the cost-effectiveness should focus on the potential differences in test parameters and prevalence in these two settings.

Figure 1

Model figure.

Figure 2

Costs and effectiveness of screening in hospital and community sites. Results of probabilistic Monte Carlo simulation (1000 trials).

Figure 3

Incremental costs between hospital and community sites, Monte Carlo simulation with 1000 trials. Negative incremental costs indicate higher costs in community sites. The solid dot shows the base case result.

Figure 4

Cost-effectiveness acceptability curve. This shows the probability that one setting is more cost-effective than another for a given ceiling value and for the assumption that prevalence in hospital sites is higher than in community sites. QCM = quality weighed detected child months.