Probabilistic Cost-utility Analysis of Universal Newborn Hearing Screening

• Main Authors: Hou-Ling Lung, 龍厚玲
• Other Authors: 陳秀熙
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/29051918898244840989

碩士 === 國立臺灣大學 === 流行病學與預防醫學研究所 === 102 === Background Congenital hearing impairment is one of the most prevalent congenital anomaly, afflicting 1 to 3 per 1000 newborn infants. Without early recognition and intervention, patients’ language ability would be delayed, leading to suboptimal school performance and production loss, which further causing significant socio-economic cost. Universal newborn hearing screening (UNHS) has been suggested for early identification worldwide. However, enormous costs would be involved for a large-scale newborn hearing screening program. The grasp of the balance between utility and costs for the implementation of such universal newborn hearing screening is of importance to health decision-maker. Aim The objective was to propose a Markov decision tree model to perform deterministic and probabilistic cost-utility analysis of universal newborn hearing screening in Taiwan. Material and methods A Markov decision tree model was framed with three strategies: UNHS with otoacoustic emission (OAE) test, automatic acoustic brainstem reflex (aABR) test, and no UNHS (natural history model). The target population was all newborn babies in health insurance system in Taiwan. The parameters for analysis were derived from literatures. The utility was evaluated using scores of Clinical Evaluation of Language Fundamentals (CELF) test. By assigning the specific statistical distribution to each parameter, Monte Carlo simulation with 5000 trials was therefore applied to capture the parameter uncertainty. We then present the outcome in terms of incremental cost-utility ratios (ICURs), acceptability curve, and incremental net benefit (INB) under varying prevention strategies. Results Cost-utility analysis reveals UNHS with OAE and aABR were the two cost-saving strategies compared with no UNHS. For a hypothetical population of 200,000 newborns, the incremental cost-utility ratios for OAE and aABR against the no screening strategy were calculated as $-4800.89 (-24475.83, 15351.54) and $-4111.23(-22540.02, 13774.97) for per utility gained, respectively. The incremental cost-utility ratio for aABR against OAE was calculated as $6273.2(-15421.2, 28936.5) for per utility gained. aABR strategy demonstrates a up to 91% higher probability of being cost-utility compared with no screening demonstrated in acceptability curve, and higher incremental net monetary benefit compared with OAE. Conclusion Compared to no screening, UNHS with OAE and aABR are both cost-saving. aABR is the most economic one. These findings, although they are still uncertain, suggest a nationwide universal newborn screening for hearing loss with aABR, from societal viewpoint, can be continued under the evidence-based principle.