The Impact of Hearing Loss and Its Treatment on Health-Related Quality of Life Utility: a Systematic Review with Meta-analysis

Abstract

Background: Hearing loss significantly impacts health-related quality of life (QoL), yet the effects of current treatments on QoL utility remain uncertain. Our objective was to describe the impact of untreated and treated hearing loss on QoL utility to inform hearing healthcare policy.

Methods: We searched databases for articles published through 02/01/2021. Two independent reviewers screened for articles that reported elicitation of general QoL utility values for untreated and treated hearing loss health states. We extracted data and quality indicators from 62 studies that met the inclusion criteria.

Results: Included studies predominately used observational pre/post designs (61%), evaluated unilateral cochlear implantation (65%), administered the Health Utilities Index 3 (HUI3; 71%), and were conducted in Europe and North America (84%). In general, treatment of hearing loss improved post-treatment QoL utility when measured by most methods except the Euro-QoL 5 dimension (EQ-5D). In meta-analysis, hearing aids for adult mild-to-moderate hearing loss compared to no treatment significantly improved HUI3-estimated QoL utility (3 studies; mean change=0.11; 95% confidence interval (CI): 0.07 to 0.14) but did not impact EQ-5D-estimated QoL (3 studies; mean change=0.0; 95% CI: -0.03 to 0.04). Cochlear implants improved adult QoL utility 1-year post-implantation when measured by the HUI3 (7 studies; mean change=0.17; 95% CI: 0.11 to 0.23); however, pediatric VAS-estimated QoL utility was non-significant (4 studies; mean change=0.12; 95% CI: -0.02 to 0.25). The quality of included studies was limited by failure to report missingness of data and low survey response rates. Our study was limited by heterogeneous study populations and designs.

Findings: Treatment of hearing loss significantly improves QoL utility, and the HUI3 and VAS were most sensitive to improvements in hearing. Improved access to hearing healthcare should be prioritized. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42021253314.

Keywords: cochlear implant; health state utility values; hearing aid; hearing loss; systematic review.

Figure 1

Literature flow diagram. The figure depicts the flow of studies from search identification to eventual inclusion or exclusion in the systematic review. We manually searched references of previously published systematic reviews identified through our search strategy for potentially relevant articles to include for assessment at the Abstract level. QoL, health-related quality of life.

Figure 2

Hearing aid meta-analyses. The figure presents the forest plots for meta-analyses of mean change scores for (A) adult acoustic hearing aids for mild-to-moderate hearing loss compared to no treatment measured by HUI3, (B) adult acoustic hearing aids for mild-to-moderate hearing loss compared to no treatment measured by EQ-5D, and (C) adult implantable hearing aids compared to pre-implantation measured by the HUI3. Estimates to the right of the x-axis show a positive utility increase after intervention. CI, confidence interval; RE, random effects.

Figure 3

Cochlear implant meta-analyses. The figure shows the forest plots for meta-analyses of mean change scores for (A) adult cochlear implantation compared to pre-implantation measured by HUI3, ≤12 months of follow-up; (B) adult cochlear implantation compared to pre-implantation measured by HUI3, >12 months of follow-up; and (C) pediatric cochlear implantation compared to pre-implantation measured by VAS. Estimates to the right of the x-axis show a positive utility increase after intervention. CI, confidence interval; mo, month; RE, random effects.