Open Access Research article

Cost-effectiveness analysis of neonatal hearing screening program in china: should universal screening be prioritized?

Li-Hui Huang12, Luo Zhang12, Ruo-Yan Gai Tobe35, Fang-Hua Qi4, Long Sun5, Yue Teng5, Qing-Lin Ke5, Fei Mai6, Xue-Feng Zhang7, Mei Zhang8, Ru-Lan Yang9, Lin Tu10, Hong-Hui Li11, Yan-Qing Gu12, Sai-Nan Xu13, Xiao-Yan Yue14, Xiao-Dong Li15, Bei-Er Qi12, Xiao-Huan Cheng12, Wei Tang4, Ling-Zhong Xu5* and De-Min Han12*

Author Affiliations

1 Beijing Tongren Hospital, Capital Medical University, Beijing, China

2 Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, China, 17 Hou-gou Lane, Chong-nei Street, Beijing 100005, China

3 Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

4 Tokyo University Hospital, Tokyo, Japan

5 Institute of Social Medicine and Health Services Management, School of Public Health, Shandong University, Wen-hua-xi Road No.44, Jinan City, Shandong Province 250012, China

6 Guangdong Province Maternal and Child Health Hospital, Guangzhou, Guangdong, China

7 Beijing Haidian District Maternal and Child Heath Hospital, Beijing, China

8 Hebei Province Langfang City Maternal and Child Health Hospital, Langfang, Hebei, China

9 Henan Province Anyang City Maternal and Child Heath Hospital, Anyang, Henan, China

10 Jiangxi Province Jiujiang City Maternal and Child Health Hospital, Jiujiang, Jiangxi, China

11 Guangxi Province Liuzhou City Maternal and Child Heath Hospital, Liuzhou, Guangxi, China

12 Beijing Shangdi Hospital, Beijing, China

13 The Third People's Hospital of Wenzhou City, Wenzhou, Zhejiang, China

14 Hebei Province Chengde City Maternal and Child Health Hospital, Chengde, Hebei, China

15 Hebei Province Tangshan City Maternal and Child Health Hospital, Tangshan, Hebei, China

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BMC Health Services Research 2012, 12:97  doi:10.1186/1472-6963-12-97

Published: 17 April 2012



Neonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China.


A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces.

Results and discussion

A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both strategies especially universal strategy achieve a good economic effect in the long term costs.


Universal screening might be considered as the prioritized implementation goal especially in those relatively developed provinces of China as it provides the best health and economic effects, while targeted screening might be temporarily more realistic than universal screening in those relatively developing provinces of China.