Cost-Effectiveness Analysis: Automated Auditory Brainstem Response (aABR) Diagnostic Test Compared to Transient Evoked Otoacoustic Emission Screening (TEOAE) for Universal Newborn Hearing Screenings (UNHS) in High-Risk Neonates

Purpose: Comorbidities and ototoxic medications increase risk of hearing loss (HL) in infants admitted to neonatal intensive care units (NICU; 6 per 1000 births) compared to well-babies (1.7 per 1000 births). For newborn hearing screening (NBHS), transient evoked otoacoustic emissions (TEOAE) testing is more efficient and less costly. Automated auditory brainstem response (aABR) testing yields higher sensitivity and specificity. This study will identify if aABR is cost-effective compared with TEOAE for NBHS in high-risk neonates. Methodology: Cost-effectiveness analysis was conducted from a healthcare system perspective. Prevalence and outcomes data for aABR, TEOAE, and auditory brainstem response (ABR) were obtained from a published study with 144 neonates admitted to the same Thailand NICU. Sensitivity and specificity were used to evaluate effectiveness. Cost was calculated from published Medicaid rates across 34 states in the United States of America. A decision tree developed in TreeAge modeled diagnostic pathways of congenital HL. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines were followed. Conclusions: aABR was more costly (mean $34.09) with higher sensitivity (.917) and specificity (.921) than TEOAE (mean $29.03; sensitivity .787; specificity .888). The incremental cost-effectiveness ratio (2.80) indicates the aABR costs an extra $2.80 per each additional true positive screening. Equity considerations are vital for ensuring cost-effective NBHS and appropriate audiology referrals.