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

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, Intervention(s), and Main Outcome Measure(s): 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 com- pliance 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 contrib- ute 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.