PEDIATRICS Vol. 118 No. 2 August 2006, pp. 844a-845 (doi:10.1542/10.1542/peds.2006-1146)
LETTER TO THE EDITOR |
Cost Savings From Universal Newborn Hearing Screening
Scott D. Grosse, PhDDanielle S. Ross, PhD
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention
Atlanta, GA 30333
To the Editor.—
Does universal newborn hearing screening (UNHS) save money by reducing expenditures on special education services for children with congenital hearing loss? An article by Schroeder et al1 in the April issue of Pediatrics provides the first empirical evidence to address this important question. The investigators produced an important new analysis of economic costs of medical and special education for children with permanent, bilateral congenital hearing loss (PCHL) and their families in selected areas of England. Here we situate their findings in the context of US-policy discussions on UNHS.
Schroeder et al compared costs among children with PCHL aged 7 to 9 years who were born in areas with or without UNHS programs, including children who participated in the Wessex trial of UNHS.2 The authors report that after adjusting for confounders, including level of hearing loss and nonverbal cognitive ability, overall costs in a given year were lower by 15% in the UNHS cohort, an absolute difference of £2213.1 This difference was not statistically significant (P = .30), but it reflects the high dispersion in individual cost data. Because of dispersion, those performing controlled trials are less likely to find statistically significant differences in costs than in clinical end points, and the appropriate focus may be estimation rather than hypothesis testing.3 Although the data are cross-sectional and observational, they result from a policy experiment, and we feel that it is reasonable to interpret the findings as reflecting a causal impact of UNHS.
From a US-policy perspective, the most important findings relate to special education costs in UNHS and non-UNHS cohorts. Previous estimates of the percentage reduction in the incremental education cost expected to be associated with hearing loss resulting from the implementation of UNHS have varied from 10% to 100%.4–7 Schroeder et al report that average education costs in the preceding year were 22% lower among the children with PCHL who were born in districts with UNHS programs, an absolute difference of £2670.1 The proportional difference is similar to the 25% reduction projected in a scenario in one previous analysis.5 Partially offsetting the lower educational costs was a 12% increase in noneducational costs in the UNHS cohort.1
The findings in the Schroeder et al study call into question the assumption underlying certain published US estimates of economic gains from newborn hearing screening that educational costs for children with severe-to-profound hearing loss can be generalized to all children detected by UNHS.6,7 Unlike studies of the economic costs of PCHL in the United States,8–10 Schroeder et al calculated average costs by level of hearing loss in the better ear. Thus, whereas children with severe PCHL had average educational costs 4.6 times higher than children without hearing loss, those with moderate PCHL had expenditures only 2.0 times higher.1 Surprisingly, the presence of an associated condition or comorbidity was not significantly associated with average costs.1
Regarding the payback period for the apparent cost savings from UNHS to offset the costs associated with implementation of UNHS, Schroeder et al calculate annual cost savings equal to 21% of the average cost to detect one child with PCHL through UNHS.1 From the US-policy perspective, one must go beyond hospital-based UNHS to encompass the costs of all aspects of early hearing detection and intervention (EHDI), including public health coordination of screening, follow-up and database management, outpatient screenings, diagnostic workups, and early intervention services. The full costs of EHDI programs should be higher than that of just the hospital-based screening component. Nonetheless, Schroeder et al provide an invaluable contribution to the development of a full cost-effectiveness analysis of EHDI programs and are to be congratulated for a first-rate empirical study.
The conclusions in this letter are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
REFERENCES
- Schroeder L, Petros S, Kennedy C, et al. The economic costs of congenital bilateral permanent childhood hearing impairment.
Pediatrics. 2006;117
:1101
–1112
[Abstract/Free Full Text] - Wessex Universal Hearing Screening Trial Group. Controlled trial of universal neonatal screening for early identification of permanent childhood hearing impairment. Lancet. 1998;352 :1957 –1964[CrossRef][Web of Science][Medline]
- Ramsey S, Willke R, Briggs A, et al. Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report. Value Health. 2005;8 :521 –533[CrossRef][Web of Science][Medline]
- Mehl AL, Thomson V. Newborn hearing screening: the great omission. Pediatrics. 1998;101(1) . Available at: www.pediatrics.org/cgi/content/full/101/1/e4
- Grosse SD. Economic evaluation of newborn hearing screening. Presented at: Washington State Newborn Screening Advisory Committee; April 15, 2002; Shoreline, WA
- Keren R, Helfand M, Homer C, McPhillips H, Lieu TA. Projected cost-effectiveness of statewide universal newborn hearing screening.
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[Abstract/Free Full Text] - Gorga MP, Neely ST. Cost-effectiveness and test-performance factors in relation to universal newborn hearing screening. Ment Retard Dev Disabil Res Rev. 2003;9 :103 –108[CrossRef][Web of Science][Medline]
- Mohr PE, Feldman JJ, Dunbar JL, et al. The societal costs of severe to profound hearing loss in the United States. Int J Technol Assess Health Care. 2000;16 :1120 –1135[CrossRef][Web of Science][Medline]
- Honeycutt AA, Grosse SD, Dunlap LJ, et al. Economic costs of mental retardation, cerebral palsy, hearing loss, and vision impairment. In: Altman BM, Barnartt SN, Hendershot G, Larson S, eds. Using Survey Data to Study Disability: Results From the National Health Interview Survey on Disability. Research in Social Science and Disability, Vol 3. London, United Kingdom: Elsevier; 2003:207–228
- Centers for Disease Control and Prevention. Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment: United States, 2003. MMWR Morb Mortal Wkly Rep. 2004;53 :57 –59[Medline]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
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