Cost-Effectiveness Analysis of a National Neonatal Hearing Screening Program in China: Conditions for the Scale-Up

BackgroundIn 2009, the Chinese Ministry of Health recommended scale-up of routine neonatal hearing screening - previously performed primarily only in select urban hospitals - throughout the entire country. MethodsA decision analytical model for a simulated population of all live births in China was developed to compare the costs and health effects of five mutually exclusive interventions: 1) universal screening using Otoacoustic Emission (OAE) and Automated Auditory Brainstem Response (AABR); 2) universal OAE; 3) targeted OAE and AABR; 4) targeted OAE; and 5) no screening. Disability-Adjusted Life Years (DALYs) were calculated for health effects. Results and DiscussionBased on the cost-effectiveness and potential health outcomes, the optimal path for scale-up would be to start with targeted OAE and then expand to universal OAE and universal OAE plus AABR. Accessibility of screening, diagnosis, and intervention services significantly affect decision of the options. ConclusionIn conclusion, to achieve cost-effectiveness and best health outcomes of the NHS program, the accessibility of screening, diagnosis, and intervention services should be expanded to reach a larger population. The results are thus expected to be of particular benefit in terms of the ‘rolling out’ of the national plan.【背景】2009年，中国卫生部推荐在全国范围内推广常规新生儿听力筛查——此前该筛查仅主要在部分城市医院开展。 【方法】本研究针对中国全部活产儿构建模拟人群的决策分析模型，以比较5种互斥干预方案的成本与健康效应：1）采用耳声发射（Otoacoustic Emission, OAE）与自动听性脑干反应（Automated Auditory Brainstem Response, AABR）的全面筛查；2）全面耳声发射筛查；3）针对性耳声发射联合自动听性脑干反应筛查；4）针对性耳声发射筛查；5）不开展筛查。采用伤残调整生命年（Disability-Adjusted Life Years, DALYs）量化健康效应。 【结果与讨论】基于成本效益与潜在健康结局，最优的推广路径应为先开展针对性耳声发射筛查，再逐步拓展至全面耳声发射筛查，以及全面耳声发射联合自动听性脑干反应筛查。筛查、诊断与干预服务的可及性对方案选择具有显著影响。 【结论】综上，若要实现新生儿听力筛查（Neonatal Hearing Screening, NHS）项目的成本效益与最佳健康结局，需拓展筛查、诊断及干预服务的可及性，以覆盖更广泛的人群。本研究结果有望对国家筛查计划的“逐步推广”工作带来显著助益。