Table 2 shows the assumptions (e.g., cost of an item, amount of time required for an activity, hourly wages, etc.) for each item. For all four pieces of equipment, we have assumed that 2,000 babies are born each year and that 100% of those babies are screened. The prevalence of hearing loss is three per thousand, and the cost of the equipment is amortized over three years. We have also assumed that a full-time employee works 1,880 hours per year, and that the cost of doing a diagnostic evaluation for any babies referred from the screening program is $150 per baby.
Equipment Purchased & Operation
Depending on what equipment you use and how the program is operated, purchase of equipment and consumable supplies for the program will be approximately 20%-50% of the total annual costs. The specific assumptions made in this analysis for each of the four types of equipment are summarized below.
Natus Algo Equipment - The cost of the Natus equipment is $17,500, and this is amortized over a three-year period. We have also assumed the purchase of a laptop computer to do data management for tracking babies through the referral and diagnostic process, since Natus does not allow their computer to have other software loaded on it. You would also need a printer for printing program management reports and letters to parents and physicians about the status of babies in the screening program. There is no cost for a cart or a label printer, since these are included with the Algo unit. Supplies are budgeted at $8.70 per baby, which is the bulk purchase price for Natus equipment, and $200 per year or 10¢ per baby for calibration costs. There are no costs for probe replacement or probe tips, since these are not used by the Natus equipment.
Bio-logic AuDX Equipment - The cost of the basic Bio-logic AuDX handheld screener is $3,995, and this is amortized over a three-year period. This includes a label printer, but you would also need a computer and printer to do tracking and data management. Probe tips for the AuDX cost $1 each, and we have assumed an average of one probe tip per baby. Although these tips can be washed and reused, most programs find it is not cost efficient to do so. Probe replacements are approximately $800, and we have estimated a probe will need to be replaced every thousand babies.
Otodynamics ILO88 Equipment - The cost of the ILO88 equipment is approximately $6,500, and this is amortized over a three-year period. The ILO88 requires a computer to operate it ($1,500), but the same computer can be used for the tracking and data management. We have also included the cost of a printer for tracking and data management and a cart for the screener, computer, and printer. Probe tips cost $1 per baby. Although they can be washed and reused, most programs find it is not cost efficient to do so. Probe replacements cost $350, and we have assumed you will need a new probe every thousand babies.
SonaMed Clarity Equipment - The cost of the equipment (including the screening DPOAE and ABR, and diagnostic DPOAE and ABR) is $25,000, and this is amortized over a three-year period. The purchase price includes a computer, printer, and cart for the equipment. Probe tips are $1 per baby. Although these can be reused, most programs treat them as consumables. The electrode packet for doing the screening ABR is $5 per packet. However, in a two-stage screening program, the screening ABR would only be done for those babies who do not pass the OAE (approximately 10% of the babies), so this averages to 50¢ per baby screened. Probe replacements are approximately $500, and we have estimated they will need to be replaced every thousand babies.
Personnel Costs
A number of different people will be involved in the newborn hearing screening program. Sometimes existing staff are used and sometimes new staff are hired. Hourly wages for each category of people involved in the screening program include the amount paid per hour, plus fringe benefits, plus hospital overhead. In our example, the coordinator is paid $20.00 an hour, plus 25% of that amount for fringe benefits, which results in $25.00 an hour, plus 30% of the salary plus fringe for hospital overhead, which results in a total of $32.50 per hour. Because none of the equipment requires special certification or professional training to operate, the same hourly rates have been used for each type of equipment. The total compensation rate (salary + fringe + overhead) for the coordinator is $32.50 per hour, for the screener is $17.88 per hour, for the clerk is $13.00 per hour, and for the audiologist is $40.63 per hour. Of course, you can change these to match the salaries for people at your hospital and see what it does to the costs. Remember to include hourly pay, plus fringe benefits, plus overhead charges in the amount you insert.
Time To Do Screening Activities - The time required per baby for any task is to take the amount of time the person(s) doing that task actually spent during a typical time period (at least a week, but preferably a month or more) and divide by the number of babies done. The assumptions used in this example are explained below. The full-time equivalent for each job category is automatically calculated by the computer.
Program Coordination - Someone needs to manage the overall program and make sure everything functions as intended. Often this is an audiologist, but it could also be done by someone else. We have estimated 3 minutes per baby or about 2 hours per week for these tasks.
Inpatient Screening - The amount of time necessary to do inpatient screening is estimated for each baby at 12 minutes for the Natus equipment, 8 minutes for the AuDX equipment, 10 minutes for the Otodynamics equipment, and 12 minutes for the SonaMed Clarity equipment. These numbers are based on reports from the field about how many babies per hour complete the screening process. Although the actual test per baby is less, the estimated time used here includes whatever time is necessary to prepare, comfort, or transport the baby, retest the baby, talk to parents, record any information about the screening, etc. Obviously, these numbers can be changed to reflect whatever assumptions you think would be applicable for your hospital.
Outpatient Screening - For outpatient screening, no time is included for the Natus Algo or the SonaMed Clarity equipment, since our example assumes these units are used for a one-stage screening protocol. The Bio-logic AuDX and the Otodynamics ILO88 equipment are assumed to use a two-stage screening protocol (inpatient and outpatient), and the same amount of time per baby is estimated for the outpatient as the inpatient.
Audiological Review - There are different opinions about how much audiological review is necessary for a hospital-based screening program. Many people take the position now that substantial audiological involvement is only required after babies are referred from the complete screening process. There are many examples of hospitals operating successful screening programs with no audiological involvement until the baby is referred for a diagnostic assessment. Most programs using OAE equipment do have some audiological involvement, but it is very little, so we have estimated one minute per baby for the OAE programs. This is about 40 minutes per week of audiological review for a hospital of this size. If you want your program to have more audiological involvement, you can increase the time in this category and see how it affects costs.
Clerical Work - Clerical work to track babies through the referral and diagnostic process is necessary regardless of what kind of equipment is being used. This person keeps track of which babies have been missed, have passed the screen, or have been referred from the initial screen; schedules appointments for follow-up assessments where necessary; sends letters to parents and physicians about the status of the screening; and compiles reports for hospital administrators and the state department of health. We have assumed 3 minutes per baby or about 2 hours per week for the Natus Algo and the SonaMed Clarity because they are a one-stage screening program, and 5 minutes per baby or about 3-1/4 hours per week for the AuDX and ILO88 since they are two-stage screening programs and will have more babies coming back for outpatient screens.
Other Assumptions
For all four options, we have assumed that all of the babies are screened prior to discharge. At the time of discharge, we have estimated a refer rate of 3% for the Natus equipment, 8% for the Bio-logic and Otodynamics equipment, and 1.5% for the SonaMed Clarity. The SonaMed Clarity is lower because they do both OAE and ABR screening for babies before they leave the hospital. These refer rates are based on reports from users in the field, as well as the published literature. Most of the published literature for Algo equipment actually report somewhat higher refer rates, but those are generally reporting studies in which the old Algo 1 equipment was used. The Algo 2 equipment has significantly lower refer rates according to people in the field.
For this analysis, we also assume that all of the babies who need an outpatient screen are actually screened. We assume that the refer rate for doing a second-stage screen for the AuDX and the ILO88 as outpatients is 10% based on published literature. The percent of babies screened before discharge who need a diagnostic evaluation and the number of babies who need a diagnostic evaluation are simply the product of the various refer rates reported above and are calculated for you by the computer.
For all of the babies, we have assumed that the HI*TRACK data and patient information management software would be used at a cost of $1.00 per baby. If a different tracking and data management software is used, such as the Oz SIMS software, the appropriate cost per baby would need to be inserted.
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