Cost-Effectiveness Analysis of Automated Auditory Brainstem Response and Otoacoustic Emission in Universal Neonatal Hearing Screening

Abstract

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.

Economic Evaluations of Childhood Hearing Loss Screening Programmes: A Systematic Review and Critique

“…This review observed that diagnostic accuracy of OAEs and ABRs, the most commonly used screening methods, varied widely across the evaluations. The sensitivity of OAEs ranged between 77% [48] and 100% [37] and that of ABRs ranged between 80% [37] and 98% [46] (see Table 3). The specificity values of OAEs ranged between 84% [46] and 99% [33] and that of ABRs ranged between 90% [42] and 97% [52].…”

“…The specificity values of OAEs ranged between 84% [46] and 99% [33] and that of ABRs ranged between 90% [42] and 97% [52]. Only one evaluation estimated testing accuracy from a meta-analysis [52]. The other evaluations based estimates of testing accuracy on a single study.…”

“…Moreover, a few evaluations overlooked important variables in the sensitivity analyses, for example, 'the proportion of children treated' [26,36]. Around one in five (17%) evaluations excluded 'loss to follow-up' (attendance at diagnostic assessment after referral from screening) in the sensitivity analysis [33,42,47,48] (includes two evaluations from Burke et al [42]).…”

The Methodological Quality and Challenges in Conducting Economic Evaluations of Newborn Screening: A Scoping Review

“…After duplicate removals, 716 articles were considered eligible for screening by title and abstract. After full-text screening, 35 articles were included for the final assessment (see Appendix C for the PRISMA flow diagram) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. No additional studies were found on the websites of the INAHTA HTA agencies.…”

Normal Hearing Function in Children Prenatally Exposed to Zika Virus

“…Regarding neonatal hearing screening, OEA exhibited sensitivity of 0.77 (confidence interval [CI] 95% 0.65-0.86) and specificity of 0.93 (CI 95% 0.92-0.93), and a-ABR exhibited sensitivity of 0.93 (CI 95% 0.87-0.96) and specificity of 0.97 (CI 95% 0.96-0.98), compared with ABR. 15 Audiometry is the gold standard for hearing loss diagnoses, but FS-ABR is considered an accurate test to estimate hearing thresholds in infants that cannot cooperate with audiometry. 16,17 Neurodiagnostic ABR is used to verify the conductibility of the auditory pathways.…”