Original Title: Application 17

Authors' results and conclusions: Safety - There was no evidence available up until 2007 that reported physical harms from universal neonatal hearing screening (UNHS). UNHS was found to cause no more psychosocial distress than a behavioural test given after the infant is 6 months old, but was associated with increased satisfaction levels. Based on the literature available it is concluded that UNHS does not cause psychosocial harm, although no data were found on the harms caused by false reassurance. Effectiveness - Diagnostic accuracy - Under quiet conditions, transient evoked otoacoustic emissions (TEOAE) possesses excellent sensitivity (up to 100%) and good specificity (92%) for diagnosing permanent hearing impaired children (PCHI). The positive predictive value of TEOAE is poor however at 1.5%. In comparison, automated auditory brainstem response (AABR) has excellent specificity (96%) and good sensitivity (80%). The positive predictive value of AABR is very low (2.2%) although marginally better than TEOAE conducted under quiet conditions. Effectiveness - Screening - Findings from one good quality level III-1 study suggests that referral for definitive diagnostic testing, actual PCHI diagnosis, and management of PCHI commonly occurs earlier and more frequently with UNHS than without it. This is supported by level III-2 average and good quality studies. The effect of UNHS on primary or patient-relevant outcomes is not readily apparent. Economics - In the short term, the costs for the additional cases identified and diagnosed by UNHS are greater per unit than those of targeted screening. However, taking a societal perspective over the long term suggests that identifying a larger proportion of hearing-impaired infants at an early stage (i.e. less than or equal to 6 months of age) would result in a cost saving overall. The validity of these estimates of long-term cost savings should be regarded with caution as they are based primarily on observational data and expert opinion. In the short term, the decision analytic model predicts that implementing a two-stage AABR UNHS program for 250,000 newborns would identify an extra 607 infants with unilateral or bilateral hearing impairment by the age of 6 months compared to no formal screening program, at an incremental cost of $6-$11 million. Where a targeted screening program is already in place, expanding to a universal screening program would identify 319 more infants, at an incremental cost of $4-$8 million. Over the long term, the States/Territories stand to save on special education and rehabilitation, and the Federal Government to save on disability support pensions.

Project Status: Completed

Year Published: 2008

URL for published report: Not Available

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)