Fitting Hearing Aids in The Netherlands

Objectives: The main objective of this article is to demonstrate the usefulness of dynamic modeling for an economic assessment of technology in health care. Specifically, this approach is applied to assess the impact of the use of hearing aids in Dutch health care. Methods: The population is divided into different health classes between which, over time, transitions occur. Transition probabilities are derived from exogenous data. The transitions are associated with economic and societal costs and benefits. People who are satisfied with their hearing aids experience benefits. These benefits are expressed by quality-adjusted life-years (QALYs). Costs are made during transitions (mainly the fitting of hearing aids). A cohort analysis is carried out, starting with people in a particular age group. The starting point is a fixed number of people within this age group, who are followed during their whole lifetime. Results: Costs per QALY ratios are calculated for two health programs. The Fitting Hearing Aid Program describes the present situation in the Netherlands; the Post-purchase Counseling Hearing Aid Program is a hypothetical addition to the first program, where an intervention based on a Dutch study is undertaken to improve satisfaction with hearing aids. Future benefits and costs are discounted at a rate of 5%. Conclusions: The dynamic modeling approach provides a more realistic picture than a static ap- proach. Particularly, the cost-effectiveness of the Fitting Hearing Aid Program is compared with the Post-purchase Counseling Hearing Aid Program. Assessment, from the economic and societal point of view, of the impact of applying medical technology in health care on the well-being of individuals by its very nature requires the use of dynamic modeling. People become ill, are treated with appropriate medical technology or interventions, may become better or worse after treatment, and so on. The total population can be divided into different health classes. Over time persons move from one health class to another according to certain transition probabilities that can be assessed empirically. These transitions may be associated with medical interventions or other factors. Economic and societal costs and benefits can be associated with these transitions, in terms of health and healthcare costs, but also, for instance, in terms of productivity losses and gains.