Background The value of SES has been questioned since the introduction of Universal Newborn Screening in 2006 which now identifies around half the cases of permanent hearing loss at birth. In 2007 a report funded by the Health Technology Assessment Programme described a lack of good evidence.

Methods Our aim was to evaluate the effectiveness and cost-effectiveness of school entry screening (SES) for hearing loss.

The project consisted of several studies, the component data from each refining and developing an existing SES economic model.

We compared the diagnostic accuracy of two screening tests; a pure-tone sweep test (PTS), and the Siemens HearCheckTM device (HC), with Pure Tone Audiometry (PTA), in children with sensorineural or permanent conductive hearing loss bilaterally (average 20–60 dB HL) or unilaterally (≥20 dB HL), and children without identified hearing loss. Second data were collected for children aged 4–6 years from referrals to an audiology service with a school screen (Nottingham) and one without (Cambridge). We also investigated the practical implementation of the two screens by school nurses.

The model parameters of the decision analytic economic model included the yield and nature of hearing impairment detected in the systems with and without SES; the yield, consequences and costs of screen positive individuals in an SES system; and the costs of setting up an SES system.

Results The referral rate was 36% lower with SES relative to no SES (rate ratio 0.64, 95% CI: 0.59 to 0.69). The yield of confirmed cases did not differ between areas with and without SES (rate ratio 0.82, 95% CI: 0.63 to 1.06; p = 0.12). The mean age of referral did not differ with and without SES for all referrals but children with confirmed hearing impairment were older at referral in the site with SES (mean age difference 0.47 years, 95% CI: 0.24 to 0.70).

The economic model demonstrated, based on cost per QALY that SES is unlikely to be cost-effective, and using base case assumptions is dominated by a no screening strategy. There are some scenarios when SES may be cost-effective.

Conclusion SES is unlikely to be cost-effective when judged against the benchmarks normally used by NICE, relative to a system reliant on ad hoc referral when a suspicion of hearing impairment is raised, The results are dependent on the Nottingham/Cambridge comparison.