Gorga Michael P, Neely Stephen T
Boys Town National Research Hospital, Omaha, Nebraska, 68131, USA.
Ment Retard Dev Disabil Res Rev. 2003;9(2):103-8. doi: 10.1002/mrdd.10066.
The first portion of this paper reviews current understanding of the cost of universal newborn hearing screening (UNHS), including capital and operating expenses, as well as the costs for follow-up testing on infants who do not pass the hearing screening test in the perinatal period. Capital expenses include the cost of equipment. Operating expenses include the costs for disposables and personnel. Follow-up costs relate to the diagnostic testing that must be performed in order to determine hearing status in those infants who do not pass the newborn hearing screening test. This section is followed by a more theoretical approach, in which test performance, prevalence, program costs, and "costs of hearing loss" are combined in a model that includes all costs of hearing loss, including screening, follow-up testing, and costs (benefits) associated with identifying hearing loss early in life. While some of the model's cost/benefit assumptions may be incorrect, the general approach of taking into account both costs and benefits provides a framework for evaluating the utility of UNHS in a more global manner. Model assumptions (costs, benefits, prevalence, sensitivity, specificity) can be changed to values deemed more appropriate, but the general approach is still informative. With the present assumptions, it is shown that initially, the costs of UNHS exceed its benefits. However, after only four years of operation, UNHS programs will result in a net savings to society. These savings increase rapidly, reaching a maximum annual benefit of seven billion dollars 75 years after initiation of the program, which is also the societal benefit for all years thereafter.
本文的第一部分回顾了目前对新生儿听力普遍筛查（UNHS）成本的理解，包括资本和运营费用，以及对围产期听力筛查未通过婴儿进行后续检测的成本。资本费用包括设备成本。运营费用包括一次性用品和人员成本。后续成本涉及为确定那些听力筛查未通过婴儿的听力状况而必须进行的诊断检测。本节之后是一种更具理论性的方法，其中将检测性能、患病率、项目成本和“听力损失成本”纳入一个模型，该模型涵盖了听力损失的所有成本，包括筛查、后续检测以及与早期发现听力损失相关的成本（收益）。虽然该模型的一些成本/收益假设可能不正确，但同时考虑成本和收益的总体方法提供了一个更全面评估UNHS效用的框架。模型假设（成本、收益、患病率、敏感性、特异性）可以更改为被认为更合适的值，但总体方法仍然具有参考价值。根据目前的假设，结果表明，最初，UNHS的成本超过其收益。然而，仅运行四年后，UNHS项目将为社会带来净节省。这些节省迅速增加，在项目启动75年后达到每年70亿美元的最大收益，此后所有年份的社会效益也是如此。
