OBJECTIVES: To compare the cost-effectiveness of 3 screening strategies in France (birth cohort of 800,000 children) as evidence for universal screening is scarce because available tests have low positive predictive value, need further development, and costs and consequences of screening are not fully known. METHODS: We entered economic/clinical data and expert opinion into a clinical decision model in order to compare: 1). Targeted screening (TS) of children with one or more risk factors for hearing disorders; 2). Universal neonatal hearing screening (UNHS) by automated auditory brainstem response (AABR); and 3). UNHS by otoacoustic emission (OAE) testing. RESULTS: 1). TS detected fewer than 15% of cases of bilateral hearing impairment; 2). AABR-based UNHS was the most efficient but also costly strategy; and 3). OAE-based UNHS gave a higher number of false positives than strategy two did. Results were sensitive to prevalence, lost-to-follow-up rates, and costs. CONCLUSION: About 1 to 3 children/1000 in France are born with at least moderate bilateral hearing impairment which should be detected and treated early for normal development (speech, cognitive and social functions). Our results for France confirm published data for other countries and can help our decision-makers prioritize screening strategies. However, longer term dynamic modeling is needed.