Societal costs of severe-to-profound hearing loss among adults without cochlear implants– A health economic evaluation using a Markov model

• Severe-to-profound hearing loss (STPHL) forms a large burden of disease and is among others in Sweden a growing public health concern due to an aging society. Cochlear implants (CI) form a safe and useful treatment for STPHL, but despite its benefits, only 13 percent of the adults with STPHL that are eligible for CI receive this treatment. To underpin the need for better treatment, a health economic evaluation has been conducted on the societal costs of STPHL among Swedish adults when not treated with CI. A better understanding of these costs might give a better insight into the need for improved treatment and can be used for discussions regarding policymaking for the treatment of STPHL. In this project, a Markov model has been created that enables the calculation of the societal costs of STPHL among adults who might be eligible for CI who do not receive this treatment. These costs are being compared to the costs of a similar group of adults without hearing loss. Next to a calculation of the costs for the Swedish society, the model can even be used for similar calculations in other Nordic countries. This report describes how the Markov model has been created, how the calculations have been conducted, and how the model can be used. As the model forms a simplified simulation of reality, several aspects of STPHL that appear in real life are missed. For the most part, this leads to an underestimation of the societal costs of STPHL when not treated with CI, which makes this model conservative. A shortage of studies regarding some of the parameters of the model leads to uncertainty in the values of these parameters and thus the calculations. More research on the topic is needed to be able to make more secure calculations. Over a period of 23 years, the additional costs of STPHL for the simulated cohort are expected to be 23,9 billion SEK, which equals approximately 1,2 million SEK per person. However, due to the uncertainties in the model one should be careful with the usage of a single number. Instead, it is highly recommended to look at how the results may change based on changing values of parameters which is possible by use of a sensitivity analysis. Most of the costs are caused by fall accidents and paid by municipalities, due to the costs for home care after fall accidents. Next to the calculations presented in this report, it would be valuable to know how high the calculated societal costs are compared to the costs of a similar cohort that does receive CI treatment. Despite that this comparison is not possible to make today due to a lack of research, it is possible to describe how the current model can be used to make the comparison between receivers and non-receivers of CI, in case the needed studies are available in the future. One of the aims of the project was to enable a similar analysis within the other Nordic countries. For this, a description of such usage has been provided at the end of this report. As the calculations only apply to the Swedish society and are based on the Swedish population, usage of the model in other Nordic countries requires changes in the values of some of the parameters in the model. Usage of the model in other countries requires more, major changes as these have different systems for health governance and funding of health care.

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