The economics of screening infants at risk of hearing impairment: An international analysis
The economics of screening infants at risk of hearing impairment: An international analysis
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DOI：
10.1016/j.ijporl.2011.11.004
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发表时间：
2012-02-01
影响因子：
1.5
通讯作者：
Taylor, Matthew J.
中科院分区：
文献类型：
--
作者：
Burke, Martyn J.;Shenton, Ruth C.;Taylor, Matthew J.
目的：世界各地儿童的听力障碍对他们的最佳发展和教育，包括语言习得构成了特别严重的障碍。每1000名新生儿和婴儿中约有0.5-6人患有先天性或幼儿期感音神经性耳聋或重度至中度听力障碍，并造成严重后果。因此，早期发现是为失聪和听力受损婴儿提供适当支助的一个至关重要的因素，这将有助于他们在社会上与所有其他儿童享有平等机会。这项分析估计的成本和有效性的各种干预措施，以筛选婴儿听力importance.Methods的风险：经济分析采用决策树的方法来确定新生儿听力筛查策略的成本效益。建立了两个独特的模型来捕捉不同的战略筛选决策。首先，比较了新生儿听力普遍筛查（UNHS）和有危险因素新生儿选择性筛查的成本效益。其次，提供一个阶段的筛选过程与两个阶段的筛选processs.Results的成本效益进行了调查：两个国家，英国和印度，被用来作为案例研究，以说明可能的成本结果与各种战略，以诊断婴儿听力损失。在英国，普遍战略导致了大约230万英镑的额外成本，但发现了额外的63例病例。据估计，每发现一个病例的增加费用为36 181磅。在印度，由于听力损失的基线患病率较高，采用普遍策略时估计的经济负担显著较高。与两阶段筛查策略相比，一阶段筛查策略在英国和印度分别额外积累了13，480和13，432例假阳性病例。这表示增加了约1.3磅百万和INR 34.6 million.Conclusions成本效益的筛查干预措施在很大程度上取决于两个关键因素。正如预期的那样，干预的成本（每位患者）大大推动了模型，成本越高，成本效益比越高。同样，听力障碍的基线患病率（风险）也会影响结果。在基线风险低的情况下，与基线风险高的情况相比，干预措施不太可能具有成本效益。(C)2011爱思唯尔爱尔兰有限公司保留所有权利。
Objective: Hearing impairment in children across the world constitutes a particularly serious obstacle to their optimal development and education, including language acquisition. Around 0.5-6 in every 1000 neonates and infants have congenital or early childhood onset sensorineural deafness or severe-to-pofound hearing impairment, with significant consequences. Therefore, early detection is a vitally important element in providing appropriate support for deaf and hearing-impaired babies that will help them enjoy equal opportunities in society alongside all other children. This analysis estimates the costs and effectiveness of various interventions to screen infants at risk of hearing impairment.Methods: The economic analysis used a decision tree approach to determine the cost-effectiveness of newborn hearing screening strategies. Two unique models were built to capture different strategic screening decisions. Firstly, the cost-effectiveness of universal newborn hearing screening (UNHS) was compared to selective screening of newborns with risk factors. Secondly, the cost-effectiveness of providing a one-stage screening process vs. a two-stage screening process was investigated.Results: Two countries, the United Kingdom and India, were used as case studies to illustrate the likely cost outcomes associated with the various strategies to diagnose hearing loss in infants. In the UK, the universal strategy incurs a further cost of approximately 2.3 pound million but detected an extra 63 cases. An incremental cost per case detected of 36,181 pound was estimated. The estimated economic burden was substantially higher in India when adopting a universal strategy due to the higher baseline prevalence of hearing loss. The one-stage screening strategy accumulated an additional 13,480 and 13,432 extra cases of false-positives, in the UK and India respectively when compared to a two-stage screening strategy. This represented increased costs by approximately 1.3 pound million and INR 34.6 million.Conclusions: The cost-effectiveness of a screening intervention was largely dependent upon two key factors. As would be expected, the cost (per patient) of the intervention drives the model substantially, with higher costs leading to higher cost-effectiveness ratios. Likewise, the baseline prevalence (risk) of hearing impairment also affected the results. In scenarios where the baseline risk was low, the intervention was less likely to be cost-effective compared to when the baseline risk was high. (C) 2011 Elsevier Ireland Ltd. All rights reserved.