Grill Eva, Uus Kai, Hessel Franz, Davies Linda, Taylor Rod S, Wasem Juergen, Bamford John
Department of Physical Medicine and Rehabilitation, University of Munich, Germany.
BMC Health Serv Res. 2006 Feb 23;6:14. doi: 10.1186/1472-6963-6-14.
Children with congenital hearing impairment benefit from early detection and management of their hearing loss. These and related considerations led to the recommendation of universal newborn hearing screening. In 2001 the first phase of a national Newborn Hearing Screening Programme (NHSP) was implemented in England. Objective of this study was to assess costs and effectiveness for hospital and community-based newborn hearing screening systems in England based on data from this first phase with regard to the effects of alterations to parameter values.
Clinical effectiveness analysis using a Markov Model.
quality weighted detected child months (QCM).
Both hospital and community programmes yielded 794 QCM at the age of 6 months with total costs of 3,690,000 pound sterling per 100,000 screened children in hospital and 3,340,000 pound sterling in community. Simulated costs would be lower in hospital in 48% of the trials. Any statistically significant difference between hospital and community in prevalence, test sensitivity, test specificity and costs would result in significant differences in cost-effectiveness between hospital and community.
This modelling exercise informs decision makers by a quantitative projection of available data and the explicit and transparent statements about assumptions and the degree of uncertainty. Further evaluation of the cost-effectiveness should focus on the potential differences in test parameters and prevalence in these two settings.
先天性听力障碍儿童可从听力损失的早期检测和管理中受益。这些及相关考虑因素促使人们建议进行普遍的新生儿听力筛查。2001年，英格兰实施了国家新生儿听力筛查计划（NHSP）的第一阶段。本研究的目的是根据第一阶段的数据，评估英格兰基于医院和社区的新生儿听力筛查系统在参数值改变影响方面的成本和效果。
使用马尔可夫模型进行临床效果分析。
质量加权检测儿童月数（QCM）。
医院和社区项目在6个月大时均产生了794个QCM，每10万名接受筛查的儿童中，医院项目的总成本为369万英镑，社区项目为334万英镑。在48%的试验中，模拟成本在医院会更低。医院和社区在患病率、检测敏感性、检测特异性和成本方面的任何统计学显著差异，都会导致医院和社区在成本效益方面的显著差异。
这项建模工作通过对可用数据的定量预测以及对假设和不确定性程度的明确和透明陈述，为决策者提供了信息。对成本效益的进一步评估应侧重于这两种情况下检测参数和患病率的潜在差异。
