Economic evaluation of hearing aid use and quality of life in older adults with hearing impairment in India

Hearing impairment is a growing public health challenge among older adults in India, with low uptake of hearing aids despite potential benefits for communication, social participation, and health-related quality of life (HRQoL). This study evaluated the cost-utility of hearing aid provision for older adults (≥60 years) with hearing impairment in India to inform policy and financing decisions. A cost-utility analysis compared hearing aid use with no hearing aid over a 3-year decision tree and a 15-year Markov model. Data were collected in 2023 from 636 participants (276 users, 360 non-users). HRQoL was measured using EQ-5D-5L and converted to QALYs with the India value set. Costs were based on the government ceiling price for digital behind-the-ear hearing aids (₹8,000 per ear), modelled for unilateral and bilateral use. ICERs and budget impact were estimated. Mean EQ-5D-5L utility was higher among hearing aid users than non-users (0.832 vs. 0.601), with corresponding QALYs of 5.824 vs. 4.207 (incremental gain 1.617 QALYs). In the 3-year decision tree, ICERs were ₹5,419/QALY (one-year) and ₹10,359/QALY (two-year). In the discounted 15-year Markov model, ICERs were ₹3,076/QALY (one-year) and ₹5,971/QALY (two-year). Budget impact was ₹1,230 crore over 3 years (₹410 crore annually) for the modelled scale-up among older adults. Hearing-aid provision for older adults with hearing impairment in India is highly cost-effective in short- and long-term modelling. Prioritising access within healthy ageing and universal health coverage, alongside strengthened assessment, fitting, counselling, and follow-up, could maximise real-world benefits.