Cost-effectiveness analysis of hearing screening program for primary school children in southern Iran, Shiraz.

BACKGROUND: Hearing loss is the second most common chronic disease, the diagnosis and treatment of which can be faster through screening. In addition, early interventions will save significant costs for the education and health systems. Therefore, the present study aimed to evaluate the cost-effectiveness of hearing screening for primary school children in Shiraz. METHODS: This cross-sectional economic evaluation of cost-effectiveness was conducted from the perspective of the health system. The study population comprised all seven-year-old children participating in the screening program in Shiraz. The present study dealt only with direct costs. The expected costs and outcomes, as well as the ICER index were estimated using the decision tree model. The study outcomes included averted disability-adjusted life years (DALY) and true identification of hearing loss cases. The robustness of the results was evaluated using the one-way sensitivity analysis. The TreeAge 2020 and Excel 2016 software were also used to analyze the collected data. RESULTS: The hearing screening data obtained during 6 years (2015-2020) showed that every year, an average of 22,853 children in Shiraz were examined for hearing, of which 260 were true positive (%1.1). The costs of screening and lack of screening were estimated at $30.32 Purchasing Power Parity (PPP) and $13.75 PPP per child, respectively. The averted DALY due to performing hearing screening was estimated at 7 years for each child. The ICER was positive and equal to $ 0.06 PPP for the identified cases and $ 2.37 PPP per averted DALY. The sensitivity analysis confirmed the robustness of the results. CONCLUSIONS: According to the results, although hearing screening for primary school children had more costs and effectiveness, it was considered cost-effective. Therefore, universal screening with high quality and accuracy is recommended.

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

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.