Economic Evaluations of Hearing Interventions in Older Adults: A Systematic Review of Evidence and Methods.

INTRODUCTION

Age-related hearing loss is common among older adults and is associated with poorer quality of life, falls, cognitive and psychosocial consequences, and increased healthcare use. Hearing aids, cochlear implants and rehabilitation services may improve outcomes, but their economic value remains unclear. This systematic review assessed cost-effectiveness and cost-benefit evidence for hearing interventions in older adults and examined methods, assumptions and outcome measures used in the evaluations.

METHODS

Medline, Embase, Scopus, Web of Science and EconLit were searched from inception to August 2026 for trial- or model-based full economic evaluations of hearing interventions in adults ≥ 60 years. Eligible studies included cost-effectiveness analyses (CEAs), cost-utility analyses (CUAs), and cost-benefit analyses (CBAs). Costs were standardised to 2024 US dollars. Quality was assessed using CHEQUE for CEAs and the Drummond checklist for CBAs.

RESULTS

A total of 27 studies in 28 articles met the inclusion criteria, of which 22 studies reported CEAs, including 19 CUAs, and 6 CBAs; 1 study reported both a CUA and a CBA. CEAs generally found cochlear implants and hearing aids to be cost-effective compared with no intervention, and cochlear implants were often cost-effective compared with hearing aids in eligible populations. Post-hearing-aid counselling or rehabilitation, transcutaneous bone conduction devices and cochlear implant processor upgrades were generally cost-effective. CBAs indicated positive net monetary benefits. Health-related quality of life was most commonly measured using the Health Utilities Index Mark 3. Costs typically included device, procedure and physician-visit costs. Key drivers included utility gains, intervention costs, age at intervention and device compliance. Limitations included omission of downstream costs, limited carer and societal impacts, inconsistent preference-based outcome measurement, insufficient model validation, limited equity analysis and no evaluations in institutional and long-term care.

CONCLUSIONS

Hearing interventions, particularly hearing aids and cochlear implants, appear to offer good economic value for older adults. Future evaluations should capture broader benefits, downstream costs, carer and long-term care impacts, and use transparent, standardised methods.