Abstract
BackgroundHearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. This study assessed the cost-effectiveness of HA for older adults who were volunteered to be screened for hearing loss in a community-based mobile hearing clinic (MHC).MethodsParticipants with (1) at least moderate hearing loss (≥40 dB HL) in at least one ear, (2) no prior usage of HA, (3) no ear related medical complications, and (4) had a Mini-Mental State Examination score ≥ 18 were eligible for this study. Using a delayed-start study design, participants were randomized into the immediate-start (Fitted) group where HA was fitted immediately or the delayed-start (Not Fitted) group where HA fitting was delayed for three months. Cost utility analysis was used to compare the cost-effectiveness of being fitted with HA combined with short-term, aural rehabilitation with the routine care group who were not fitted with HA. Incremental cost effectiveness ration (ICER) was computed. Health Utility Index (HUI-3) was used to measure utility gain, a component required to derive the quality adjusted life years (QALY). Total costs included direct healthcare costs, direct non-healthcare costs and indirect costs (productivity loss of participant and caregiver). Demographic data was collected during the index visit to MHC. Cost and utility data were collected three months after index visit and projected to five years.ResultsThere were 264 participants in the Fitted group and 163 participants in the Not Fitted group. No between-group differences in age, gender, ethnicity, housing type and degree of hearing loss were observed at baseline. At 3 months, HA fitting led to a mean utility increase of 0.12 and an ICER gain of S$42,790/QALY (95% CI: S$32, 793/QALY to S$62,221/QALY). At five years, the ICER was estimated to be at S$11,964/QALY (95% CI: S$8996/QALY to S$17,080/QALY) assuming 70% of the participants continued using the HA. As fewer individuals continued using their fitted HA, the ICER increased.ConclusionsHA fitting can be cost-effective and could improve the quality of life of hearing-impaired older individuals within a brief period of device fitting. Long term cost-effectiveness of HA fitting is dependent on its continued usage.
Highlights
Hearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap
mobile hearing clinic (MHC) The MHC is a community outreach program staffed by a team of audiologists, research assistants and trained audio technicians that offers hearing diagnostic tests, referrals general practitioners (GP) or ENT specialist clinic, HA fitting and short-term post-fitting audiological rehabilitation services
A total of 3657 residents were screened at the MHC between December 2015 and June 2017, of which, 439 residents met the study criteria and were keen on adopting HA
Summary
Hearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. The latest global burden of disease (GBD) study reported age related hearing loss to be the third leading cause of years lived with disability (YLD) [3]. An estimated 434 million adults experience disabling hearing loss, with nearly one third over the age of 65 years [4]. More than 38 million adults in United States (US) experience hearing loss (> 25 dB HL), of which two-thirds of the adults were over the age of 70 years [5,6,7]. Due to ageing population trends, the global prevalence of older adults with hearing loss is projected to double by year 2060 [4, 6, 7]
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