Release: Embargo until September 24, 2000Contact: Jennifer Felsher202-371-4517 (9/23-27)703-519-1549[email protected]
STUDY CITES MOST COST-EFFECTIVE HEARING TEST FOR NEWBORNS
Otoacoustic Emissions Testing with Follow-up Is Found to Be the Most Effective and Least Costly Method for Newborn Hearing Screening
Washington, DC -- Cost of testing remains a significant barrier to universal implementation of newborn hearing screening programs. In the first half of 1990, it was recommended by Federal agencies that all infants undergo a screening test for hearing to facilitate earlier intervention for those found to be congenitally deaf. Early intervention has been shown to be beneficial to quality of life and decreases incidence of difficulty in later learning development. The federal government has pledged $3.5 million to assist states in establishing such programs. However, there is no requirement for states and hospitals to start newborn hearing screening; that decision has been left to individual hospitals -- hence, the concern regarding costs.
Researchers have found that otoacoustic emissions testing with a follow-up of the same (OAE/OAE) is the most effective and least costly of various methods for testing newborns for hearing ability. It is estimated that as many as six infants of every 1000 are born with permanent congenital hearing loss. The otoacoustic emissions test is designed to pick up very faint sounds produced by the ear, thought to represent mechanical vibrations in the cochlea, a cone-shaped cavity in the inner ear which produces sound sensation.
The authors of the study, "The Cost Effectiveness of Universal Screening for Hearing Loss in Newborns" are Eric J. Kezirian, MD MPH, Bevan Yueh, MD and Sean D. Sullivan, PhD all of the University of Washington, Seattle and Karl R. White, PhD, of the National Center for Hearing Assessment and Management in Logan, Utah. The findings will be presented Tuesday, September 26 at the American Academy of Otolaryngology -- Head and Neck Surgery Foundation Annual Meeting/Oto Expo being held September 24-27, 2000, at the Washington, DC Convention Center.
This study compared four methods of testing, representing 95 percent of all methods in use throughout the United States, for cost and cost-effectiveness. The results are to be used as a comparison to assist hospitals in their choice of screening method.
Methodology: A decision analysis model was constructed to include four protocols that represent 90% of the screening programs in pediatric care facilities. Using the hospital perspective, the protocols were compared using the variables of cost, screening test sensitivity, and screening test specificity. The four tests used were: screening auditory brainstem response with follow-up of the same (S-ABR/S-ABR), screening auditory brainstem response with no follow-up (S-ABR/None), otoacoustic emission testing with follow-up of the same (OAE/OAE), and otoacoustic emission testing with follow-up of screening auditory brainstem response with no follow-up (OAE the S-ABR/None). In contrast to the OAE test, the ABR test presents sounds to the ear and detects nervous system activity in specific locations of the hearing pathway.
Cost was determined as the total cost per infant screened, from the initial test up to and including diagnostic evaluation (if required). Effectiveness was defined as the number of infants with hearing loss identified specifically through the screening program. Cost-effectiveness was determined to be a ratio of the two; cost per infant identified with hearing loss. The sole outcome measure was the number of infants with hearing loss identified through newborn screening.
Results: Otoacoustic emissions testing at birth followed by repeat testing at follow-up (OAE/OAE) was found to be the least costly at $13 per infant with the lowest cost-effectiveness ratio at $5100 per infant with hearing loss identified. Screening auditory brainstem response testing at birth with no screening test at follow-up (S-ABR/None) was the only protocol to demonstrate a greater effectiveness. However, this method has a greater cost at $25 per infant, and also provided the highest cost-effectiveness ratio at $9500 per infant with hearing loss identified.
Conclusions: Cost is a significant factor in the implementation of universal newborn hearing screening programs. As such, it is suggested that hospitals concerned with cost-effectiveness select the otoacoustic emission testing with follow-up (OAE/OAE).
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For additional information regarding this research study or an interview with the authors, contact Ken Satterfield or Jennifer Felsher at 202-371-4517 (9/23-9/27), or by e-mail at [email protected] and [email protected]
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