The Cost-Effectiveness and Budget Impact of a Community-based Universal Newborn Hearing Screening Program in the Philippines

Background Hearing loss is one of the top 20 contributors to the global burden of disease.1 Congenital or early childhood onset sensorineural deafness occurs in about 0.5 to 5 in every 1 000 neonates. If the condition remains undetected during infancy, the child becomes highly at risk for having impaired language and communication development. It has been demonstrated that detection/intervention by 6 months up to before the first year of life can prevent the loss of normal development and lead to a child with communications skills at par with his or her normal peers.2 Due to the potential gains of early intervention, the World Health Organization in 2000 recommended that “a policy of universal neonatal screening be adopted in all countries and communities with available rehabilitation services and that the policy be extended to other countries and communities as rehabilitation services are established.“3 Despite this recommendation, the implementation of a universal hearing screening program in member states has been varied. Developed countries like the US and Germany having greater resources and better equipped health systems were able to take up universal screening programs.4 Concerns of limited resources and the capital intensive universal screening has led to the development of targeted newborn hearing screening (TNHS) which utilizes a questionnaire to screen high risk infants that would require further testing. Those who pass will not undergo testing and will translate to less cost of testing for the program. However, TNHS misses around half of those with congenital hearing screening as these babies lack any risk factor.5 Costeffectiveness analysis done by Blanco and Moreno-Ternero (2013)6 noted that from a healthcare facility perspective, TNHS is more cost-effective but from a societal one, universal newborn hearing screening (UNHS) is preferred. Huang et al. (2012)7 found that UNHS and TNHS are both cost-effective for eight8 China provinces but UNHS tend to require better program coverage, diagnosis rate and intervention rate. They also noted that eventually total savings would exceed total program implementation costs. Santos-Cortez and Chiong conducted a cost-analysis of universal hearing screening in the Philippines. According to their computations, a universal hearing screening program translated to savings in the long term.8 This study, along with the other literature on newborn hearing screening, has led to the creation of the Republic Act 97091 Universal Newborn Hearing Screening and Intervention Act of 2009. This cost-analysis was, however, based on model of screening conducted in the hospital prior to discharge. An alternative model is to conduct screening at the community level linked to vaccination clinics. This was demonstrated to be a feasible model in Nigeria.9 The screening was done by trained community health workers. They were able to cover 88% of the 2,277 eligible babies visiting vaccination clinics with a low refer rate of 4.1%. The Budget Universal Newborn Hearing Screening