Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss

Abstract

Importance: Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare.

Objective: To determine whether HA use is associated with health care costs and utilization in older adults.

Design, setting, and participants: This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated.

Exposures: Encounter with the US health care system.

Main outcomes and measures: (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits.

Results: Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, -$81 to -$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, -2% to -2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, -3% to -1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, -0.47 to -0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0).

Conclusions and relevance: This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.

Figure 1.. Adjusted Estimated Mean Treatment Outcome of Hearing Aids (HAs) on Health Care Costs

Data obtained from the 2013-2014 Medical Expenditure Panel Survey, Household Component File. All differences are significant at α = .05.

Figure 2.. Adjusted Estimated Mean Treatment Outcome of Hearing Aids (HAs) on Any Use of Health Care Services

Data obtained from the 2013-2014 Medical Expenditure Panel Survey, Household Component File. Results are based on manually estimating the treatment outcomes of HAs on cost, using generalized linear models with a logistic distribution. All differences are significant at α = .05. Percent change is calculated as (with HA − without HA) / without HA • 100. Percentage points are calculated as percent of individuals with HA − percent of those without HA. ED indicates emergency department.

Figure 3.. Adjusted Estimated Mean Treatment Outcome of Hearing Aids (HAs) on Number of Health Care Services Used, if Any

Data obtained from the 2013-2014 Medical Expenditure Panel Survey, Household Component File. Results are based on manually estimating the treatment outcomes of HAs on cost, using generalized linear models with a negative binomial distribution. Differences in office visits and nights in the hospital are significant at α = .05. Percent change is calculated as (with HA − without HA) / without HA • 100. ED indicates emergency department.