Cost-effectiveness analysis of a national neonatal hearing screening program in China: conditions for the scale-up

Abstract

Background: In 2009, the Chinese Ministry of Health recommended scale-up of routine neonatal hearing screening - previously performed primarily only in select urban hospitals - throughout the entire country.

Methods: A decision analytical model for a simulated population of all live births in china was developed to compare the costs and health effects of five mutually exclusive interventions: 1) universal screening using Otoacoustic Emission (OAE) and Automated Auditory Brainstem Response (AABR); 2) universal OAE; 3) targeted OAE and AABR; 4) targeted OAE; and 5) no screening. Disability-Adjusted Life Years (DALYs) were calculated for health effects.

Results and discussion: Based on the cost-effectiveness and potential health outcomes, the optimal path for scale-up would be to start with targeted OAE and then expand to universal OAE and universal OAE plus AABR. Accessibility of screening, diagnosis, and intervention services significantly affect decision of the options.

Conclusion: In conclusion, to achieve cost-effectiveness and best health outcomes of the NHS program, the accessibility of screening, diagnosis, and intervention services should be expanded to reach a larger population. The results are thus expected to be of particular benefit in terms of the 'rolling out' of the national plan.

Figure 1. Decision tree for cost-effectiveness analysis of different screening strategies among all simulated live births in China.

Figure 2. The cost in per Disability-Adjusted Life Years (DALYs) of four screening strategies compared with no screening.

Uni.OAE+AABR = universal strategy using OAE plus AABR; Uni.OAE = universal strategy using OAE; Select.OAE+AABR = targeted strategy using OAE plus AABR; Select.OAE = targeted strategy using OAE; Reference = 3 times of GDP per capita (19,700 international dollars).

Figure 3. Sensitivity analysis of willingness-to-pay.

Figure 4. The impact of the benefit ratio on ACER of different screening strategies based on the results of sensitivity analysis.

Uni.OAE+AABR = universal strategy using OAE plus AABR; Uni.OAE = universal strategy using OAE; Select.OAE+AABR = targeted strategy using OAE plus AABR; Select.OAE = targeted strategy using OAE; ACER = Average Cost-Effectiveness Ratio.

Figure 5. The impact of the benefit ratio on ICER of shifting strategies based on the results of sensitivity analysis.

Uni.OAE+AABR = universal strategy using OAE plus AABR; Uni.OAE = universal strategy using OAE; Select.OAE+AABR = targeted strategy using OAE plus AABR; Select.OAE = targeted strategy using OAE; ICER = Incremental Cost-Effectiveness Ratio.