This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database.

Institute of Health Economics. Screening newborns for hearing: the use of the automated auditory brainstem response and otoacoustic emissions tests for newborn hearing screening. Edmonton: Institute of Health Economics (IHE). Spring 2007. 2007

1. To review the social considerations for the provision of UNHS using Automatic Otoacoustic Emissions (AOAE) and/or Automated Auditory Brainstem Response (AABR) (either alone or in combination) to screen for PCHI in Alberta. 2. To review the published evidence on the efficacy/effectiveness and safety of using AOAE and/or AABR (either alone or in combination) for UNHS. 3. To review the economic literature for the provision of AOAE and/or AABR (either alone or in combination) for UNHS and to determine which screening protocol is cost-effective using an economic model.

This review's findings suggest that: UNHS using AOAE and/or AABR technology (either alone in a 2-stage protocol) is effective in terms of increasing early identification of moderate to profound PCHI and may lead to early intervention in diagnosed infants (before 6 months). The 1-stage screening protocol using AABR is a cost effective alternative to the 1-stage screening protocol using AOAE, which is less accurate and costs more. The 2-stage protocol (using AOAE followed by AABR) is more effective with higher expected costs compared to the 1-stage screening protocol using AABR. It is a value judgment if whether correctly identifying one additional infant is worth the additional cost. If UNHS is implemented, those considering AOAE and/or AABR technologies (either as a 1-stage protocol or a 2-stage protocol) should be aware that: AOAE and/or AABR cannot screen for all types and degrees of PCHI. The screening accuracy of AOAE and/or AABR depends on many factors including the cut-off impairment and the screening protocol used. The efficacy/effectiveness of AOAE and/or AABR in terms of longer-term outcomes may be difficult to establish because developmental outcomes are related to more factors than just the accuracy of the screening technologies. The AOAE and/or AABR technologies are still evolving. This review also leads to several conclusions that are especially relevant to the implementation of Newborn Hearing Screening programs: Alberta data currently collected/reported does not allow for an analysis of prevalence of PCHI or a definitive analysis of the current age of diagnosis of PCHI individuals. The creation of a registry of PCHI individuals would be necessary for the effective evaluation of any form of Newborn Hearing Screening Program. The safety and clinical efficacy of UNHS has not been established by well-designed clinical trials and only limited evidence supports the pivotal assumption of a UNHS program which is that early detection of PCHI leads to more effective habilitation. The available evidence suggests that a UNHS program's effectiveness is lower than efficacy estimates based upon analysis of the technology's characteristics alone. Specific strategies to minimize failure to screen and loss to follow-up are integral in the implementation of UNHS. Although there is limited evidence to suggest that UNHS is superior to selective screening, data that directly compare the short- and long-term benefits and harms of these alternatives is still lacking. Higher false positive rates (and therefore increased audiological assessments) threaten the cost-effectiveness of UNHS over selective screening programs. The weakest link in the evidence chain is the demonstration that earlier detection of individuals not located by a selective screening program will receive more effective habilitation. In view of the widespread adoption of UNHS programs in Canadian provinces, the potential to perform a natural experiment in Alberta to contribute to the evidence base around Newborn Hearing Screening is worth consideration.

Subject indexing assigned by CRD

Evoked Potentials, Auditory, Brain Stem; Hearing; Hearing Tests; Humans; Infant, Newborn; Neonatal Screening; Otoacoustic Emissions, Spontaneous

English

Canada

Alberta

An English language summary is available.

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32007000485

02/10/2007

02/10/2007