The Cost Effectiveness of Newborn Hearing Screening Program: New Approach of Iran Ministry of Health and Medical Education in 2022

Background: In Iran’s newborn hearing screening (NHS) program, OAE and AABR are administered to early identify hearing impairment in the primary health care (PHC) system. Objectives: The aim of this study was to conduct a cost-effectiveness analysis of this program integrated into Iran's health system. Methods: We examined the cost-effectiveness of AABR and OAE screening procedures in infants less than 1 month old. TreeAge 2022 software was used for cost-effective modeling. In this study, QoL and QALY were considered as the outcome measures. To evaluate the robustness of the modeling results, we used one-way sensitivity analysis. A ± 20% variation was utilized to determine target variables and estimate the costs per identification. Results: In 2022, a total of 1,106,072 babies were born in Iran, of whom 1,006,293 underwent hearing impairment screening (coverage rate: 90.97%). Overall, 3,359 of the newborns screened were diagnosed with hearing problems, indicating a mean prevalence of 3.3 per 1000 births. The ICER was equal to 3297.2 US PPP (Purchasing Power Parity) per QALY. According to our results, the dominant cost-effective strategy for hearing impairment screening was OAE plus AABR. After 1000 iterations, the second cost-effective strategy was found to be OAE alone, according to Monte Carlo simulation modeling. Conclusions: In this study, we evaluated the cost-effectiveness of the NHS program for detecting hearing impairment in over a million births in Iran. A two-step screening approach, including OAE and AABR, was found to be the dominant cost-effective strategy to identify newborns with hearing impairment.