Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Ear Hear. 2021 July/Aug;42(4):909-916. doi: 10.1097/AUD.0000000000000981.
Early detection of neonatal hearing impairment moderates the negative effects on speech and language development. Universal neonatal hearing screening protocols vary in tests used, timing of testing and the number of stages of screening. This study estimated the cost-effectiveness of various protocols in the preparation of implementation of neonatal hearing screening in Albania.
A micro-simulation model was developed using input on demography, natural history of neonatal hearing impairment, screening characteristics and treatment. Parameter values were derived from a review of the literature and expert opinion. We simulated multiple protocols using otoacoustic emissions (OAE) and automated auditory brainstem response (aABR), varying the test type, timing and number of stages. Cost-effectiveness was analyzed over a life-time horizon.
The two best protocols for well infants were OAE followed by aABR (i.e., two-stage OAE-aABR) testing in the maternity ward and single-aABR testing. Incremental cost-effectiveness ratios were €4181 and €78,077 per quality-adjusted life-year gained, respectively. Single-aABR screening led to more cases being detected compared to a two-stage screening program. However, it also resulted in higher referral rates, which increased the total costs of diagnostics. Multi-staged screening decreased referral rates but may increase the number of missed cases due to false-negative test results and nonattendance.
Only the 2-stage OAE-aABR (maternity ward) protocol was below the willingness-to-pay threshold of €10,413 for Albania, as suggested by the World Health Organization, and was found to be cost-effective. This study is among the few to assess neonatal hearing screening programs over a life-time horizon and the first to predict the cost-effectiveness of multiple screening scenarios.
新生儿听力障碍的早期检测可减轻其对言语和语言发育的负面影响。普遍的新生儿听力筛查方案在使用的测试、测试时间和筛查阶段数量上有所不同。本研究旨在评估各种方案在阿尔巴尼亚实施新生儿听力筛查中的成本效益。
使用人口统计学、新生儿听力障碍自然史、筛查特征和治疗方面的输入，开发了一个微观模拟模型。参数值源自文献回顾和专家意见。我们使用耳声发射（OAE）和自动听性脑干反应（aABR）模拟了多种方案，测试类型、时间和阶段数量各不相同。在终生范围内分析了成本效益。
对于健康婴儿，两种最佳方案是在妇产科病房进行 OAE 后进行 aABR（即两阶段 OAE-aABR）测试和单次 aABR 测试。增量成本效益比分别为每获得一个质量调整生命年增加 4181 欧元和 78077 欧元。与两阶段筛查方案相比，单次 aABR 筛查可检测到更多病例。然而，它也导致转诊率升高，从而增加了诊断总成本。多阶段筛查降低了转诊率，但由于假阴性测试结果和未就诊，可能会增加漏诊病例的数量。
只有两阶段 OAE-aABR（妇产科病房）方案符合世界卫生组织建议的阿尔巴尼亚 10413 欧元的意愿支付阈值，被认为是具有成本效益的。本研究是为数不多的在终生范围内评估新生儿听力筛查方案的研究之一，也是第一个预测多种筛查方案成本效益的研究。
