The Value of Hearing Aids for the Italian NHS: A Cost-utility Analysis

Giulia Fornaro; Patrizio Armeni; Andrea Albera; Michele Barbara

doi:10.1097/ONO.0000000000000018

The Value of Hearing Aids for the Italian NHS: A Cost-utility Analysis

Otol Neurotol Open. 2022 Oct 26;2(4):e018. doi: 10.1097/ONO.0000000000000018. eCollection 2022 Dec.

Authors

Giulia Fornaro^{1

2}, Patrizio Armeni¹, Andrea Albera³, Michele Barbara⁴

Affiliations

¹ Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy.
² Department of Social and Political Science, Bocconi University, Milan, Italy.
³ Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Turin, Italy.
⁴ Department of Otorhinolaryngology, "Mons. Dimiccoli" Hospital, Barletta, Italy.

Abstract

Objective: Hearing loss (HL) prevalence in Italy is expected to increase due to population aging. Hearing aids (HAs) are the main tool for HL rehabilitation; however, cost-utility analyses of HAs are limited. Our objective was to estimate the cost-utility of HAs use.

Study design: Cost-utility analysis.

Setting: Italian National Healthcare Service, societal perspective.

Patients interventions and main outcome measures: A multistate Markov model was developed to model a cohort of 55-year-old individuals starting from normal hearing and moving across HL states to compare cost-utility and net monetary benefit of HA use accompanied by post-purchase service, HA use alone, and no treatment. Parameters were estimated using secondary data. Incremental cost-utility ratio (ICUR) and incremental net monetary benefit (INMB) were computed against a €16,625/quality-adjusted life year (QALY) willingness-to-pay (WTP) threshold. Deterministic and probabilistic sensitivity analysis (DSA, PSA) was implemented to assess how uncertainty affected results. Scenario analysis was performed on different assumptions on costs, dropout and compliance rates.

Results: The model suggests HAs use is a cost-effective strategy compared to no treatment (in the base case: incremental costs €429-€476, incremental QALY gain 0.18 and 0.19, ICUR €2'404/QALY-€2'450/QALY, INMB €2'476-€2'682 for male and female cohort, respectively). By assuming no dropout, INMBs increase up to €10,643-€10,728. DSA highlights that utility weights contribute the most to model uncertainty, PSA shows that the treatment has 97.8%-97.3% probability of being cost-effective at the WTP threshold considered.

Conclusions: We proposed an original model to assess the cost-utility of HAs use; the application to the Italian setting suggests the treatment is cost-effective, reinforcing the importance of early uptake.

Keywords: Cost-utility analysis; Hearing aids; Hearing loss; Net monetary benefit analysis.