Is Newborn Hearing Screening Cost Effective? Economic Consideration for Policy Makers

Fatemeh Jafarlou, Behzad Najafi, Seyed Jalal Sameni


Backgroud: Hearing loss is the most common congenital disorder that appears as a unilateral or bilateral deafness. Early detection by screening and appropriate intervention lead to better oral communication and language development. The aim of this study was to evaluate the cost per new case identification of neonate hearing screening. Methods: The cost effectiveness of two stage hospital based newborn hearing loss screening was evaluated in this study. We gathered data for 11168 newborns born in 10 hospitals. We included a direct cost and new case identification as cost and outcome measures from health system prospective in our model. Results: We found 19 new cases with hearing loss from 11168 screened neonates (1.7 per 1000). The referral rates in the first and second stages were respectively 28% and 7%. The total cost of screening program was 132167 US$. The main cost item is screening test (OAE). Conclusions: We concluded cost per new case detection is 6956 US$ in Iranian neonate hearing screening program. Almost, it is equal to GDP per capita and it may be cost effective. Since there are many strategies to screening of newborn, it is suggested that all alternative screening strategies be analyzed by a cost effectiveness method to find the best strategy for hearing loss screening.


Cost benefit analysis; hearing loss; infant; mass screening

Full Text:



Farhadi M, Mahmoudian S, Mohammad K, Daneshi A. The

pilot study of a nationwide neonatal hearing screening in Iran:

Akbarabadi and Mirzakouchak‑Khan hospitals in Tehran (June

‑October 2004)‑In Persian. HAKIM 2006;9:65-75.

Torkaman M, Amirsalari S, Ghasemi Firouzabadi M. Evaluation

of universal newborn hearing screening with transient‑evoked

otoacoustic emission and auditory brainstem response:

A cross‑sectional study with the literature review‑In Persian.

J Isfahan Med Sch 2012;30:1209-17.

Firouzbakht M, Eftekharardebili H, Majlesi F. Determination of

hearing loss prevalence in centers of provinces‑In persian. Public

Heal Fac 2007;5:1-9.

Uus K, Bamford J, Taylor R. An analysis of the costs of

implementing the National Newborn Hearing Screening

Programme in England. J Med Screen 2006;13:14-9.

Vohr BR, Oh W, Stewart EJ, Bentkover JD, Gabbard S, Lemons J,

et al. Comparison of costs and referral rates of 3 universal

newborn hearing screening protocols. J Pediatr 2001;139:238–44.

Paul AK. Early identification of hearing loss and centralized

newborn hearing screening facility‑the Cochin experience. Indian

Pediatr 2011;48:355-9.

Pisacane A, Auletta G, Toscano F, Errichiello M, Barrier F,

Riccardi P, et al. Feasibility and effectiveness of a population‑based

newborn hearing screening in an economically deprived region of

Italy. Int J Pediatr Otorhinolaryngol 2013;77:329-33.

Hessel F, Grill E, Schnell‑Inderst P, Siebert U, Kunze S, Nickisch A,

et al. Economic evaluation of newborn hearing screening: Modelling

costs and outcomes. Ger Med Sci 2003;1:1–10.

Grill E, Uus K, Hessel F, Davies L, Taylor RS, Wasem J, et al.

Neonatal hearing screening: Modelling cost and effectiveness of

hospital‑and community‑based screening. BMC Health Serv Res

;6:14. doi: 10.1186/1472‑6963‑6‑14.

Cao‑Nguyen M‑H, Kos M‑I, Guyot J‑P. Benefits and costs

of universal hearing screening programme. Int J Pediatr

Otorhinolaryngol 2007;71:1591-5.

Olusanya BO, Luxon LM, Wirz SL. Benefits and challenges of

newborn hearing screening for developing countries. Int J Pediatr

Otorhinolaryngol 2004;68:287-305.

Mehl AL, Thomson V. Newborn hearing screening: The great

omission. Pediatrics 1998;101:1-6.

Ciorba A, Hatzopoulos S, Busi M, Guerrini P, Petruccelli J,

Martini A. The universal newborn hearing screening program at

the University Hospital of Ferrara: Focus on costs and software

solutions. Int J Pediatr Otorhinolaryngol 2008;72:807-16.

Molini E, Ricci G, Baroni S, Ciorba A, Bellocci A, Simoncelli C.

Identifying congenital hearing impairment. Personal experience

based on selective hearing screening. Acta Otorhinolaryngol Ital


Mauk GW, Beherens TR. Historical political and technological

context associated with early identification of hearing loss.

Semin Hear 1993;14:1-17.

Katz J, Gabbay WL, Ungerleider DS, Wilde L. Handbook of

Clinical Audiology. 6th ed. New York: Williams & Wilkins

Baltimore, London; 2009. p. 545‑60.

Moeller MP. Early intervention and language development

in children who are deaf and hard of hearing. Pediatrics


Joghataei M, Saadati S, Rahgozar M. Epidemiology of hearing

loss in Iran‑In Persian. Med Refinement 2004;54:49-55.

Rahimi F, Firouzbakht M, Esmaeilzadeh M, Mahmoudian S,

Alaeddini F, Rafiei M. A Comprehensive Program of Universal

Newborn Hearing Screening. Birjand: 4derakht Press; 2014. p. 21‑41.

Siegel JE, Torrance GW, Russell LB, Luce BR, Weinstein MC,

Gold MR. Guidelines for pharmaco‑economic studies:

Recommendations from the panel on cost effectiveness in health

and medicine. Pharmacoeconomics 1997;11:159-68.

Yoshigana‑Itano. Benefits of early intervention for children with

hearing loss. Otolaryngol Clin North Am 1999;32:1089-102.

JCIH. Joint Committee on Infant Hearing. Year 2000 position

statement: Principles and guidelines for early hearing detection

and intervention programs. Pediatrics 2000;106:798-817.

Sarafraz M, Hekmat Shoar M, Zaheri S. Determination of

hearing loss prevalence in preschool children of Ahvaz. Iran J

Otorhinolaryngol 2011;23:75‑9.

Academy. American Academy of Pediatrics Task Force on

Newborn and Infant Hearing. Newborn and infant hearing loss:

Detection and intervention. Pediatrics 1999;103:527-30.

Lemons J, Fanaroff A, Stewart EJ, Bentkover JD, Murray G,

Diefendorf A. Newborn hearing screening: Costs of establishing

a program. J Perinatol Off J Calif Perinat Assoc 2002;22:120-4.

Vohr BR, Carty LM, Moore PE, Letourneau K. The Rhode

Island hearing assessment program: Experience with statewide

hearing screening (1993–1996). J Pediatr 1998;133:353-7.

Maxon AB, White KR Behrens TR, Vohr BR. Referral rates and

cost efficiency in a universal newborn hearing screening program

using transient evoked otoacoustic emissions. J Am Acad Audiol


Huynh MT, Pollack RA, Cunningham RA. Universal newborn

hearing screening: Feasibility in a community hospital. J Fam Pr


Gabbard SA, Thomson V. Considerations for universal newborn

hearing screening, audiologic assessment & intervention. Audiol

Today 1998;1:8–10.

Mason JA, Herrmann KR. Universal infant hearing screening by

automated auditory brainstem response measurement. Pediatrics


White KR, Mauk GW Brandt C. Newborn hearing screening

in the United States: Is it becoming the standard of care?

In: Spivak L, editor. Universal Newborn Hearing Screening.

New York: Thieme; 1997. p. 225-55.

Yousefi J, Ajalloueyan M, Amirsalari S, Hassanali Fard M. The

specificity and sensitivity of transient otoacustic emission in neonatal

hearing screening compared with diagnostic test of auditory brain

stem response in Tehran hospitals. Iran J Pediatr 2013;23:199-204.

Prieve BA, Beauchaine KL, Sabo D, Schooling T, Culpepper B,

Tharpe AM. Evidence‑based systematic review of newborn

hearing screening using behavioral audiometric threshold as a

gold standard. Am Speech Lang Hear Assoc 2013;33:1-34.

Grein AJ, Lemons MB Weiner GM. What is the most

cost‑effective strategy for implementing universal newborn

hearing screening? Pediatr Res 2001;49:195.

Weirather YP, Korth N, White KR. Cost analysis of

TEOAE‑based universal newborn hearing screening. J Commun

Disord 1997;30:477‑93.

Grosse S. The costs and benefits of universal newborn hearing

screening. In: Paper presented to the Joint Committee on Infant

Hearing. Alexandria. 1997.

Rai N, Thakur N. Universal screening of newborns to

detect hearing impairment—Is it necessary? Int J Pediatr

Otorhinolaryngol 2013;77:1036-41.

Kemper AR, Downs SM. A cost‑effectiveness analysis of

newborn hearing screening strategies. Arch Pediatr Adolesc Med