Children with congenital hearing impairment benefit from early detection and treatment of their hearing loss . A pilot phase of a Newborn Hearing Screening Programme (NHSP) by the British National Health Service aims at early detection of hearing impairment in new-borns and includes sites where the screening is performed by Health Visitors at a home visit (community-based screening, C), in contrast to the 'hospital based' (H) model where babies are screened in maternity hospital. Objective: To predict the costs and benefits for hospital and community-based systems in England with regard to the effects of alterations to parameter values. Design: Cost-effectiveness analysis using a Markov model ). Data Sources: Preliminary data on costs and screen performance from the phase one implementation and published diagnostic studies. Target Population: All newborns. Time Horizon: 6 and 120 months. Perspective: Health care system. Compared Strategies: H and C. Outcome Measures: Quality adjusted detected child months (QCM) and incremental cost-effectiveness ratio (ICER). Both H and C yielded 794 QCM at the age of 6 months with total costs of 3,69 Mio Β£ per 100,000 screened children in H and 3,34 Mio Β£ in C. In Monte Carlo simulation costs would be lower in H in 48% of the trials. Prevalence of hearing impairment had the most important influence on costs per QCM. Extremes analyses showed that any statistically significant difference between H and C in prevalence, test sensitivity, test specificity and costs would result in significant differences in cost-effectiveness between H and C. ICERs for extreme values are presented. The cost-effectiveness of H and C did not differ significantly but did indicate the high level of uncertainty in the estimates. Projected costs per detected child were comparable to the costs found by other newborn hearing screening models . As a part of ongoing research the NHSP evaluation aims to identify factors predicting a favourable cost-effectiveness ratio.