A Systematic Review and Distributional Cost‐Effectiveness Analysis of Hearing Health Care in Chile: Equity Concerns and Trade Offs for Bone Conduction Implants

Speaker(s)

Kiesewetter K1, Der C2, Bravo Torres S3, Hoch A1, Scandurra F4, Dejaco T1, Schwarz C4, Schlick B4, Suzumura EA4, Urban M5
1MED-EL Medical Electronics, Innsbruck, Austria, 2Dr. Luis Calvo Mackenna Children’s Hospital, Santiago de Chile, Región Metropolitana, Chile, 3Clinica Alemana Universidad del Desarrollo, Chile, Región Metropolitana, Chile, 4MED-EL Medical Electronics, Innsbruck, 7, Austria, 5MED-EL Hearing Technology GmbH, Innsbruck, Austria

OBJECTIVES: Equity concerns are central to healthcare and public health policy. Chile is one of the most flourishing economies in Latin America. A survey carried out by the National Disability Fund in 2004 showed that 1.8 % of the total Chilean population was seriously hearing impaired whereas 40 % had mild to moderate hearing loss (HL). Access to HL diagnosis and treatment is hampered at many levels, negatively impacting individuals’ quality of life. This study will present on two main objectives: first, a systematic review aimed to identify barriers and social determinants contributing to any stratification of hearing health in Chile. Second, a distributional cost-effectiveness analysis (DCEA) was conducted to estimate the effect of identified disparities affecting health equity.

METHODS: A systematic review on inequalities in hearing health in Chile was conducted, and narratively synthetized. By applying a DCEA, baseline distributions of quality-adjusted life expectancy were estimated across equity subgroups. Differences in baseline health, treatment effects, and opportunity costs were examined. Potential trade-offs between maximizing population health and reducing health inequalities were investigated.

RESULTS: Age of implantation and type of hearing loss are the most prominent determinants of hearing health in Chile. While treatment options are generally accessible at a very early age in life, uncertainty about access for people affected by progressive HL or when becoming hearing impaired at a later stage in life remain unclear. Results of the DCEA showed that regardless of age of implantation, treatment with BCIs increased overall population health while reducing inequalities to access in hearing healthcare.

CONCLUSIONS: To our knowledge, this is the first DCEA to quantify equity implications of funding BCIs in Chile. In future, these analyses may help to improve both health and equity in hearing healthcare.

Code

EE772

Topic

Economic Evaluation, Health Policy & Regulatory, Medical Technologies, Study Approaches

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation, Health Disparities & Equity, Medical Devices

Disease

Medical Devices, Sensory System Disorders (Ear, Eye, Dental, Skin)