It's called hybrid construction. You can do PCB stuff and IC packaging stuff, all in one place.
I'd suspect the screened connections are lower tolerance than photo-etched (compare the tolerance on PCB silkscreen to soldermask or copper). But certainly good enough for placing some chip components on.
Other methods include direct nichrome (or other resistive alloy) deposition, followed by photochemical or laser etching, to get precise shapes and controlled resistances. Laser drilling to apply vias on the ceramic substrate; alternating layers of enamel and metal paste to get multilayer construction; etc.
No idea what the typical NRE is, but I'm sure it's not small. When you're making a billion of a thing, like automakers do, you can negotiate astonishingly low prices even for things like this.
Tim