This suggests that there may be significant recall and reporting bias in under-5 childhood morbidity in DHSs. Caution should be used in the interpretation and use of data from DHSs and the survey methods should be reviewed.

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Background: During the last decade, the rapid expansion of universal neonatal hearing screening (UNHS) has brought into focus questions about the most appropriate screening technology for this indication. Objectives:The main aim of this study was to examine the cost-effectiveness of automated auditory brainstem response (AABR) and otoacoustic emissions (OAE) in universal neonatal hearing screening programs. Methods: This economic study was performed in Iran. A decision tree model was applied for economic evaluation of the AABR and OAE devices used in UNHS. The main inputs of our model included the prevalence of hearing loss in Iran, device sensitivity, specificity and cost per case, as well as definite diagnosis of each newborn. Upon collection, these inputs were analyzed with TreeAge economic analysis software. Sensitivity analysis was conducted upon examining the probability of uncertainty concerning the inputs. Results: For a one-year period and a one-million population of newborns, the UNHS entails a cost of $3,310,700 and detects 4,650 newborns with hearing loss, using the AABR device. However, if the OAE device is used, the cost will be expanded to $3,414,100 and 3,850 newborns with hearing loss will be detected. Consequently, the AABR device costs $103,400 less than the OAE device, and detects 800 more cases than the OAE device. Sensitivity analysis results revealed that the prevalence rate or costs of the gold standard had no effect on displacing the dominant technology. Conclusions: In this study, it was found that the AABR is the cost-effective alternative compared to OAE. AABR dominates OAE, because it has lower expected costs and higher effectiveness.

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