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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

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

BMC Health Services Research > Ausgabe 1/2012
Li-Hui Huang, Luo Zhang, Ruo-Yan Gai Tobe, Fang-Hua Qi, Long Sun, Yue Teng, Qing-Lin Ke, Fei Mai, Xue-Feng Zhang, Mei Zhang, Ru-Lan Yang, Lin Tu, Hong-Hui Li, Yan-Qing Gu, Sai-Nan Xu, Xiao-Yan Yue, Xiao-Dong Li, Bei-Er Qi, Xiao-Huan Cheng, Wei Tang, Ling-Zhong Xu, De-Min Han
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-97) contains supplementary material, which is available to authorized users.
Li-Hui Huang, Luo Zhang contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

WT, LZX and DMH designed the study. LHH, LZ, RYGT, FHQ, LS, YT, QLK, FM, XFZ, MZ, RLY, LT, HHL, YQG, SNX, XYY, XDL, BEQ and XHC collected data for the study. LHH, LZ, RYGT and FHQ analyzed the data and contributed to the writing of the paper.



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.
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