Societal Benefit of Early Hearing Detection and Intervention
Cost analyses afford a way to demonstrate the efficacy and utility of a health intervention by establishing the conditions in which the benefits of treatment outweigh the monetary costs. To date, few have used cost analyses to demonstrate the long-term societal benefits of treatments for individuals with communication disorders. This paper seeks to fill this gap by developing an analytic model to measure the societal costs and benefits associated with early hearing detection and intervention (EHDI). We used decision tree analysis to develop a life-cycle cost analysis of three newborn hearing screening protocols (one-tier screening, two-tier screening with inpatient rescreening, and two-tier screening with outpatient rescreening) from a societal perspective. The outcome of the analysis was net benefit per infant screened in the form of employment productivity over the lifespan. The lifetime expected benefit from EHDI exceeded lifetime expected cost for all hearing screening protocols with input values held at average estimates. However, the one-tier hearing screening protocol yielded the highest net benefit per infant screened ($1,371.41), followed by two-tier inpatient hearing screening ($719.89) and two-tier outpatient screening ($306.31). While changes in loss to follow-up, language outcomes, and equipment accuracy each changed the long-term net benefit of EHDI, no single variable independently affected the balance between costs and societal benefit. Rather, sensitivity analyses revealed that the interdependent relationship among equipment accuracy, intervention outcomes, and loss to follow-up drove the costs and the benefits of EHDI. Program administrators, third-party payers, and policy-makers should consider all three of these variables a high priority when selecting protocols and strategies for quality improvement. Maximizing societal benefit requires a balance between treatment outcomes that yield employment productivity, highly accurate equipment, and low loss to follow-up.