Table 2.

Cost Analysis of Proposed Universal Newborn Hearing Screening in Colorado

YearYearly CostsCumulative Costs/Savings
Initial Screen CostsConfirmatory Evaluation CostsCost of InterventionCumulative CostCumulative Eval and Therapy SavingsCumulative Education SavingsNet Cost or (Savings)
11.450.20.071.72001.72
21.450.20.203.56003.56
31.450.20.265.470.1005.37
41.450.20.267.380.790.146.46
51.450.20.269.292.130.616.55
61.450.20.2611.24.041.325.84
71.450.20.2613.16.032.254.82
81.450.20.2615.08.013.413.58
91.450.20.2616.910.04.812.09
101.450.20.2618.812.06.430.37
111.450.20.2620.714.08.27(1.57)
121.450.20.2622.616.010.4(3.80)
• Figures shown in millions of dollars. All figures in 1996 dollars.

Notes: Calculations based on the following assumptions:

All cost figures reflect estimated true costs, not charges.

54 000 births per year, every year.

Frequency of congenital bilateral hearing loss 2 per 1000 newborns

Cost per initial screening, $25 per infant; cost of follow-up program and coordinator, estimated at$100 000 per year included in initial screening costs.

Cost of confirmatory evaluation, $125 per infant who fails initial screening, unilateral or bilateral; costs based on a refer rate of 3.0% of all newborns failing initial screening. Cost of intervention associated with amplification$1200 per year for 2 years in follow-up costs. The cost of the amplification device, required both for infants with early diagnosis and with late diagnosis, has been excluded from calculations.

Age of diagnosis if not screened at birth assumed to be 30 months.

Cost of confirmatory late diagnosis estimated to be $400 per affected child, for behavioral testing and brainstem auditory evoked response with sedation. Cost of therapy savings estimated at$40 true cost per session, 3 days per week, 50 weeks per year, for 3 years, for each child with prevention of delayed diagnosis of bilateral sensorineural hearing loss; zero therapy savings estimated if unilateral.

Cost of preschool educational savings estimated as follows: assuming that half of children with delayed diagnosis would require 1 year of early intervention preschool home program ($2600 per year), followed by 1 year of specialized preschool ($6200 per year), avoidable if diagnosed at birth.

Cost of school-age educational savings estimated as follows: Assuming delayed diagnosis results in 13% residential placement (cost exceeding standard education by $25 000 per year), 23% self-contained classroom ($8300 per year excess costs), 28% resource programs ($2300 per year excess costs), and 34% consultative/itinerant programs ($700 per year excess costs), and assuming that identification at birth would allow for a one-level shift to less-intensive educational setting for only half of each cohort as they enter the educational system, for the first year and each subsequent year; finally, assuming all educational savings apply only to prevention of delayed diagnosis of bilateral sensorineural hearing loss, with zero educational savings for treatment of unilateral hearing loss. (Costs and percentages: Colorado Department of Education, 1993 data.)

Model assumes that infants identified with congenital sensorineural hearing loss do not move out of Colorado during the 10-year period.

Negative net costs shown in parentheses are the equivalent of net savings.