Cost-effectiveness analysis of neonatal hearing screening program in china: should universal screening be prioritized?

Abstract

BackgroundNeonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China.MethodsA cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces.Results and discussionA multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both strategies especially universal strategy achieve a good economic effect in the long term costs.ConclusionsUniversal screening might be considered as the prioritized implementation goal especially in those relatively developed provinces of China as it provides the best health and economic effects, while targeted screening might be temporarily more realistic than universal screening in those relatively developing provinces of China.

Screening for neonatal deafness in resource-poor countries: challenges and solutions

“…The term "permanent congenital and early-onset hearing loss", or simply "hearing loss", is used more broadly to capture all degrees of hearing loss based on hearing threshold in the better ear averaged over frequencies 0.5, 1, 2, and 4 kHz, classified as: mild (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), moderate (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), moderately severe (50-64 dBHL), severe (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79), and profound (80)(81)(82)(83)…”

“…33 This is corroborated by more recent studies on the cost-effectiveness of NHS in the People's Republic of China, which also has vast underdeveloped communities. 34,35 WHO experts further reiterate that regardless of the approach adopted, the EHDI program should be linked to existing health care, social, and educational systems, and that the procedures and outcomes of the program be documented for effective follow-up. 33 Additionally, the need to ensure that targeted/selective hearing screening (THS) was based on context-specific risk factors, ideally guided by findings from well conducted pilot UHS programs and other local epidemiological data, is emphasized.…”

Current situation and prospects of newborn screening and treatment for Phenylketonuria in China - compared with the current situation in the United States, UK and Japan

“…Newborn screening combined with a Phe-restricted therapeutic diet throughout childhood can help to control the progress of PKU for most patients (11). Research shows that with a higher newborn screening rate, earlier treatment can be received by patients, and the prognosis will be better (12)(13)(14). Therefore, an effective newborn screening for PKU is indeed needed.…”

“…However, PKU is a treat-able and prevent-able disease (9,10). A screening program, especially early detection, combined with a Phe-restricted therapeutic diet can help to control the development of PKU for most patients (11)(12)(13)(14).…”

Newborn screening and related policy against Phenylketonuria in China

“…Newborn screening combined with a Phe-restricted therapeutic diet throughout childhood can help to control PKU in most patients (5). Studies have shown that a higher rate of newborn screening and earlier treatment can lead to a better prognosis for patients (6)(7)(8).…”