OBJECTIVE To compare the cost effectiveness of various strategies for neonatal hearing screening by estimating the cost per hearing impaired child detected.

DESIGN Cost analyses with a simulation model, including a multivariate sensitivity analysis. Comparisons of the cost per child detected were made for: screening method (automated auditory brainstem response or otoacoustic emissions); number of stages in the screening process (two or three); target disorder (bilateral hearing loss or both unilateral and bilateral loss); location (at home or at a child health clinic).

SETTING The Netherlands

TARGET POPULATION All newborn infants not admitted to neonatal intensive care units.

MAIN OUTCOME MEASURE Costs per child detected with a hearing loss of 40 dB or more in the better ear.

RESULTS Costs of a three stage screening process in child health clinics are €39.0 (95% confidence interval 20.0 to 57.0) per child detected with automated auditory brainstem response compared with €25.0 (14.4 to 35.6) per child detected with otoacoustic emissions. A three stage screening process not only reduces the referral rates, but is also likely to cost less than a two stage process because of the lower cost of diagnostic facilities. The extra cost (over and above a screening programme detecting bilateral losses) of detecting one child with unilateral hearing loss is €1500–4000. With the currently available information, no preference can be expressed for a screening location.

CONCLUSIONS Three stage screening with otoacoustic emissions is recommended. Whether screening at home is more cost effective than screening at a child health clinic needs further study.