Hearing Aids and Cochlear Implants Deliver Strong Value for Older Adults, Major Review Finds

Hearing loss is one of the most common conditions of ageing, and one of the most neglected. A sweeping new systematic review published in Advances in Therapy has now compiled the economic evidence behind the devices and services designed to treat it, and the verdict is striking: hearing aids, cochlear implants and related rehabilitation programmes are generally a sound investment for health systems, even before their full societal benefits are counted. The review, led by Smriti Raichand, Shan Jiang and Junling Weng alongside colleagues at Macquarie University, Fudan University and other institutions, analysed 27 studies reported across 28 publications, standardising every cost figure to 2024 US dollars to allow fair comparison across countries and decades.

The scale of the underlying problem is enormous. Age-related hearing loss affects roughly one in five people worldwide, and according to the World Health Organization about 65 percent of people living with hearing loss are aged 60 or older. In the United States, 35 percent of adults aged 65 to 74 report hearing loss, rising to 73 percent among those aged 75 and above. The consequences ripple far beyond the ear: hearing loss is associated with 1.5-fold higher odds of falls, 1.2-fold higher odds of cognitive decline, and elevated risks of loneliness and social isolation. Untreated hearing loss in Americans aged 50 and over was linked to approximately US$22,434 in additional healthcare costs over a decade, some 46 percent higher expenditure than for those with normal hearing, alongside more hospital stays and readmissions.

To assess whether treating this condition is worth the money, the researchers searched five bibliographic databases and applied strict eligibility criteria. Only full economic evaluations qualified: cost-effectiveness analyses comparing costs with health outcomes, cost-utility analyses that measure benefit in quality-adjusted life years, or QALYs, and cost-benefit analyses that translate both costs and health gains into money. Studies had to involve adults aged at least 60, or at least 50 where the focus was explicitly age-related hearing loss. Quality was appraised using the CHEQUE checklist for cost-effectiveness analyses and the Drummond checklist for cost-benefit studies, and the team converted all incremental costs into 2024 US dollars using IMF-based inflation indices and purchasing power parities.

The headline finding is consistent across the evidence base. Cochlear implants were cost-effective compared with no intervention in all seven studies that tested that comparison, with incremental cost-effectiveness ratios ranging from about US$10,541 to US$84,279 per QALY gained, well within the thresholds most health systems use to judge value. Bilateral implantation cost roughly US$15,860 per QALY against no implant. In three studies cochlear implants also proved cost-effective relative to hearing aids in eligible patients with severe to profound loss, with figures such as US$10,030 per QALY in Switzerland and US$18,220 per QALY in Finland. Hearing aids themselves were cost-effective against no intervention, and adding post-fitting counselling or auditory rehabilitation to hearing aid provision produced additional value, with one study reporting an ICER as low as US$4,606 per QALY gained.

Less familiar interventions also scored well. Upgrading cochlear implant sound processors before obsolescence was cost-effective in nearly all scenarios modelled by an Australian microsimulation study, although upgrading too early, before roughly 11 years of use, pushed the ICER above cost-effective territory. Transcutaneous bone conduction devices proved cost-effective compared with older percutaneous systems in both Swedish and Spanish analyses, largely because the newer devices carry a lower risk of complications; although the transcutaneous procedure itself cost more, around US$13,733 versus US$3,236, fewer severe skin reactions kept total costs close. Cost-benefit analyses, which monetise benefits directly, uniformly reported positive net monetary benefits for hearing aids, implants, rehabilitation services and even a hypothetical future regenerative therapy.

Beneath the favourable headline numbers, however, the review exposes deep methodological fault lines that explain why published ICERs for seemingly similar interventions can differ by an order of magnitude. The instrument used to measure quality of life turned out to be a decisive factor. Fifteen of the 22 cost-effectiveness studies used the Health Utilities Index Mark 3, or HUI-3, which includes attributes for hearing and speech and is far more sensitive to hearing-related change than the more widely used EQ-5D. In one Dutch analysis, the ICER for hearing aids swung from EUR 286,866 per QALY when utilities were derived from EQ-5D to just EUR 15,811 per QALY with HUI-3, an eighteen-fold difference caused purely by measurement choice. A meta-analysis cited in the review found a mean utility gain of 0.11 with HUI-3 but effectively zero with EQ-5D.

Other technical choices mattered too. Most studies used Markov models over a lifetime horizon, but discount rates ranged from 0 to 6 percent, perspectives varied between the health system and society, and cost components were inconsistent. Only six studies included adverse event costs, just one counted productivity losses among caregivers, and almost none captured downstream costs such as fall-related injuries, which can exceed US$60,000 per event in the United States, or post-implant speech therapy, which can cost up to US$2,309 per week. Only eight of the model-based studies conducted any formal validation of their economic models, and few used probabilistic sensitivity analysis to quantify uncertainty. The review’s authors used the CHEQUE tool to show that reporting quality has improved steadily since 2015, but methodological rigour has lagged behind.

Age emerged as another powerful driver of value. Studies reporting results across multiple age bands consistently found higher ICERs when interventions were delivered later in life, chiefly because shorter remaining life expectancy leaves less time to accumulate QALY gains. This pattern was seen for both cochlear implants and hearing aids, raising delicate policy questions about timing: earlier intervention yields better economics and may also blunt the social, psychological and cognitive consequences of untreated deafness, yet the review cautions that even at advanced ages, implants remained cost-effective, so the numbers do not support rationing by age.

The review also identifies glaring blind spots in the evidence map. Not a single included study evaluated hearing interventions for older adults in nursing homes or long-term care, despite roughly one in four older adults needing such care and the high prevalence of hearing loss and dementia in those settings. Only one cost-benefit study included people with dementia, finding modest benefits of hearing aids on dementia symptoms, and no cost-effectiveness analysis has ever done so. Just one study came from a low- or middle-income country, leaving decision-makers in much of the world without locally relevant data, a serious problem where out-of-pocket payment and high upfront device costs are the dominant barriers. No study examined over-the-counter hearing aids within a full cost-effectiveness framework, even as that consumer market expands rapidly.

The authors close with a blueprint for better research: use utility instruments sensitive to hearing, report both societal and health system perspectives, include caregiver spillover effects, fall costs and rehabilitation services, validate models systematically with tools such as AdViSHE, and embrace multidisciplinary models of care rather than evaluating devices in isolation. For now, though, the message for ageing populations is clear. The devices that restore connection to conversation, music and the social world are among the better buys in modern medicine, and the true value of hearing care is almost certainly greater than the published numbers suggest, because the studies counting the costs have so far overlooked many of the benefits.

Subject of Research: Cost-effectiveness of hearing interventions for age-related hearing loss in older adults

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

Article References: Raichand, S., Jiang, S., Weng, J., Ahumada-Canale, A., Lenzen, S., Dawes, P., Parkinson, B., Chen, Y., & Gu, Y. (2026). Economic Evaluations of Hearing Interventions in Older Adults: A Systematic Review of Evidence and Methods. Advances in Therapy. https://doi.org/10.1007/s12325-026-03788-w

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03788-w

Keywords: hearing loss, hearing aids, cochlear implants, cost-effectiveness, quality-adjusted life years, older adults, health economics, systematic review, audiology, rehabilitation, QALY, health policy