Cost-effectiveness of hearing aids in the hearing-impaired elderly: A probabilistic approach

Objective: Hearing aids are the principal tool for rehabilitation of hearing loss, one of the most prevalent impairments among elderly adults, but cost-utility ratings for hearing aid use are limited. Design: Cost-effectiveness analysis. Setting and Patients: A multistate Markov model was constructed to model 50- to 80-year-old patients moving between states, including normal hearing, mild, moderate, or severe hearing loss. Parameters assigned in the model are partly derived from the Medline source (1966-2005) and partly from data on hearing-impaired elders (n = 96) in a tertiary care center in Taiwan. To address uncertainty, most of the parameters were specified by distributions, rather than base-case values. A probabilistic approach with Monte Carlo simulations was performed to produce an acceptability curve, showing the probabilities of being cost-effective given threshold values of willingness (WTP). Main Outcome Measures: Hearing-related quality-adjusted life-years and cost in US dollars and Euros. Results: The incremental costs for gaining an additional hearing-related quality-adjusted life-years in women and men were US S 135615 ((sic) 10,826) and 9,702 ((sic) 7,715), respectively. The probability of being cost-effective increased to 53% in women and 65% in men given a WTP of US $12,000 ((sic)9,542). The probabilities of being cost-effective to reach plateau were 67% for women and 78% for men given a WTP of US $20,000 ((sic) 15,904). Conclusion: By modeling different degrees of hearing loss with a multistate model, hearing aid use was demonstrated to be a cost-effective strategy to rehabilitate the hearing-impaired elderly. These results can assist policy makers in allocating health resources appropriately and effectively.