Cost-effectiveness analysis on implementing newborn hearing screening programmes in a low- to middle-income country

Abstract

Objective

To analyse the cost-effectiveness (CE) of implementing different newborn hearing screening protocols in a low- to middle-income country.

Design

A decision analytical model with a 78-year time horizon.

Study sample

Direct medical, direct non-medical and indirect costs were collected from 126 subjects in southern Thailand. Various protocols involving universal newborn hearing screening (UNHS) and targeted newborn hearing screening (TNHS), using two technologies, namely automated otoacoustic emissions (aOAEs) and automated auditory brainstem responses (aABRs), were evaluated. Incremental cost-effectiveness ratios (ICERs) were calculated for all protocols in United States dollars (US$)/quality-adjusted life year (QALY) gained. Also, probabilistic sensitivity analyses with 1000 trials for each specific protocol were performed.

Results

The ICERs of UNHS with aOAE, UNHS with aABR, TNHS with aABR and UNHS with optimised baseline parameters were 3702, 3545, 1545 and 2483 US$/QALY gained, respectively. With the CE threshold of 5000 US$/QALY gained, the chances of ICERs to be cost-effective for UNHS with aOAE, UNHS with aABR, TNHS with aABR and UNHS with optimised baseline parameters were 72, 77, 93 and 94%, respectively.

Conclusions

All screening protocols were considered as cost-effective, and a very high chance of being cost-effective for UNHS could be achieved when certain baseline parameters were optimised.

Keywords:

• Cost-analysis
• cost-utility analysis
• developing country
• universal hearing screening
• cost-effectiveness analysis
• Thailand

Acknowledgements

As it is crucial to use cost and outcome parameters as locally as possible for the best cost-effectiveness analysis in any settings, please visit https://otology-audiology.web.app/ or download the app via https://play.google.com/store/apps/details?id=com.projectborn to use it as a helpful tool for adjusting any parameters most relevant to such settings.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The research was supported by a grant from the Faculty of Medicine, Prince of Songkla University, Thailand.