The cost―effectiveness of newborn hearing screening

Research output: Contribution to journalArticle

Abstract

Early identification and intervention for hearing loss is supposed to reduce delay in language development. Universal newborn hearing screening(NHS)programs are already being implemented in many countries worldwide. However, only a small number of economic evaluations have been conducted to examine the long―term cost―effectiveness of NHS. The aim of this study was to evaluate the short―and long―term public benefits and financial costs of NHS, and the improvements that could be effected to increase its cost―effectiveness. We conducted this cost―effectiveness analysis using the data of the Okayama Prefecture Project on NHS. The cost―effectiveness analysis, conducted from the societal perspective, compared the projected outcomes of 1)NHS for a hypothetical birth cohort of 16,000 infants, and 2)no newborn hearing screening. The probability and cost estimates for the decision model were obtained from the data of the Okayama Prefecture Project on NHS. We constructed a retrospective―cohort model to estimate the costs of education(elementary school and junior high school)and welfare up to the age of 20 years for the bilateral hearing impaired. About 90% of newborns in Okayama Prefecture were screened, including with the automated auditory brainstem response(AABR)technology. The initial referral rate was 2.30%, which dropped to 0.55% after the second―stage screenings, and the prevalence rate of bilateral hearing loss was 0.13%. The total cost of NHS for 16,000 infants and of hearing examination for the referred infants was estimated to be 93,308,160 yen, and the estimated cost of hearing examination for hearing―impaired children who had not undergone UNHS was 621,504 yen. In compulsory educational institutions, the rate of advancement to local public schools was 7.6% higher than that to special support schools. The welfare allowance for children with disabilities was 8.8% lower. The total public costs of NHS, examination, education, welfare and hearing aid/cochlear implant was 795,939,526 yen for the children who had undergone NHS, and 807,593,497 yen for those who had not undergone NHS. Even if NHS is fully paid for by public fees, the amount is likely to be reimbursed. Reduction of compulsory education expenses and welfare allowance for children with disabilities reflects the improvement of the communication skills through hearing of hearing―impaired people. There is a statistical limitation to this interpretation, because changes in the acceptance status of compulsory education for the disability could have contributed to the reduction of the education expenses. However, we conclude that early identification by NHS results in lower costs of education and welfare, and that NHS offers has the potential for long―term cost savings compared with no screening.

Original languageEnglish
Pages (from-to)1258-1265
Number of pages8
JournalJournal of Otolaryngology of Japan
Volume121
Issue number10
DOIs
Publication statusPublished - 2018

Keywords

  • Childhood hearing impairment
  • Cost
  • Effectiveness
  • Newborn hearing screening

ASJC Scopus subject areas

  • Otorhinolaryngology

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