UNSAF

1. UNSAF Personal, social and economic consequences of hearing loss Kim Ruberg Secretary General Hear-It AISBL

2. Aims of project • To carry out wide review of literature on effects of hearing impairment including • prevalence of hearing impairment in Europe • psychosocial effects of hearing impairment • use of hearing aids • costs of hearing impairment • To estimate current costs to Europe of untreated hearing impairment

3. Scope of project • Hearing impaired adults only • Hearing impairment that would benefit from hearing aids • eg not tinnitus • Definitions of Europe • European Union (25 member states) • Continent of Europe (not Russia, Turkey, includes Ukraine)

4. The Bridget Shield report at a glance • Hearing loss is much more prevalent and damaging to individuals and society and the benefits from proper treatment are much greater than previously believed. • The cost to society of untreated hearing loss is a staggering 215 billion euro a year for all of Europe and 170 billion euro a year for the countries of the European Union. • The most comprehensive scientific empirical study ever performed of the consequences of hearing loss.

5. Prevalence of HL in Europe Data from studies of the prevalence of HL in several European countries have been reanalysed to estimate the current prevalence of different grades of HL in Europe May be underestimates owing to upper age limits of 75 and 80 in studies considered

6. Hearing loss causes loneliness/social isolation psychiatric disturbance/depression low self esteem employment difficulties memory loss prejudice/abuse Hearing loss affects overall quality of life family relationships education general health visiting doctor social life going to restaurants, theatres, church etc Psychosocial effects of hearing loss Hearing loss reduces overall quality of life

11. Impact of hearing aids on quality of life Results of many studies over past 25 years • Greater self confidence and higher self-esteem • Reduced deterioration in psychological functioning • Reduction in physical health difficulties • Psychosocial improvements • Greater satisfaction with life and less depression • Benefits in social life, group activities,family relationships • Satisfaction higher with greater hearing loss/does not depend on age • Better emotional life • Better cognitive functioning • Greater overall health status Improvements occur in first few weeks after fitting

16. Evaluation of costs of hearing loss Method • Review of previous studies • Selection of method • Determination of values of required data • Calculations

17. Cost effectiveness of cochlear implants • Uses ‘cost utility analysis’ • method of evaluating cost effectiveness of medical interventions • Based upon ‘health utility index’ and ‘quality adjusted life year’ (QALY) • Health utility index: number between 0 and 1 • 1 corresponds to full health, 0 to death • Average value of HUI for adult in Europe is 0.85 (Sorri et al, 2001)

18. Cost effectiveness of cochlear implants Meta analysis of nine previous studies (Cheng and Niparko, 1999) • All studies assigned health utility values to profoundly deaf adults with and without cochlear implants • Results of all studies very consistent

19. Evaluation of hearing loss in Europe Quality of life approach Data required • Numbers of hearing impaired people in Europe • Numbers of people who would benefit from hearing aids but do not have them • Quality of life value for each degree of hearing loss • Monetary value associated with full quality of life year

20. Prevalence of HL in Europe Assumed prevalence in Europe Population of Europe (millions)

21. Prevalence of HL in Europe Estimates of numbers of HI adults in Europe who would benefit from hearing aids (ie BEHL >= 25 dB) (millions)

22. Evaluation using QoL approach • Need to assign HUI to degrees of HL Following values have been assumed:

23. Evaluation using QoL approach • Need to assign value to full quality life year European Commission value (2003) 44,000 euros • Annual cost of hearing impairment per person:

24. Evaluation using QoL approach Total costs (Millions of euros) Overall costs (billions of euros)

25. Evaluation using QoL approach Costs of unaided hearing impairment (billions of euros) Assuming 1 in 4 hearing impaired people use aid NB - underestimate as even if 1 in 4 own an aid, fewer will use one

26. Conclusion Using this method Cost to European Union of hearing loss is between 170 and 226 billion euros annually Cost to whole of Europe of hearing loss is between 215 and 286 billion euros annually

27. Australia2006 Hear-It2006

29. Untreated Hearing Loss Costs France 19-25 Billion Euro per Year • Untreated hearing loss costs France 19-25 billion euros per year, according to a new, previously undisclosed multinational scientific report, ”Evaluation of the Social and Economic Costs of Hearing Impairment”. This equals 350-400 euros per year for each person in France. • 16% of all adult French, more than 7,5 million people, suffer from a hearing loss of more than 25 dB, the definition of hearing loss recognised by the World Health Organisation, WHO. People with a hearing loss of more than 25 dB generally have daily problems caused by their hearing loss. Yet, fewer than one in six of those who could benefit from using hearing aids are being treated adequately

30. New international scientific report shows:More than 7.5 Million Hearing Impaired in France • Just a small minority of those in need use hearing aids even though hearing aids can ensure employment and improve quality of life. • 16% of all adult French citizens, more than 7.5 million people, suffer from a hearing loss of more than 25 dB, the definition of hearing impairment recognised by the World Health Organisation, WHO. People with a hearing loss of more than 25 dB generally have daily problems caused by their hearing loss. At work conversations with colleagues, and the concentration needed for communication during the day demand much energy, potentially affecting both mood and work efficiency. Untreated hearing loss may also affect your social and family life, lower your quality of life and cause mental anguish.

31. What to do about it • We try to document and persuade • Document – that life quality is reduced drastically if you have a hearing loss • Document – that treating your hearing loss drastically increases your quality of life • Document – that a hearing loss decreases your productivity and your income • Document – that this loss in productivity and income is reduced by treating your hearing loss. • Document – that proper intervention against hearing loss is one of the best investments for any society.

32. UNSAF Thank you for listening Personal, social and economic consequences of hearing loss Kim Ruberg Secretary General Hear-It AISBL

36. Help us (and yourself): State the facts loudly • - The costs of untreated hearing are so high economically to society and in terms of personal consequences for so many individuals that we must take this problem seriously, on the individual level and as a society. • - With 16 % of all adults suffering from hearing loss, we all have to be more aware of the problem and talk about it without prejudices. In particular, I find it extremely important that family doctors generally must be more focused on potential hearing loss in individual patients. • - Typically, the closest family members are most deeply affected when a person has a hearing loss. Conversations become shorter, less frequent, less spontaneous and less personal. They sense a loss of intimacy, withdrawal and changed personality.

37. Help us (and yourself): State the facts loudly • - As a family member of a hearing impaired individual you can do a lot to help. Most often relatives are the ones to first discover when someone may have a hearing loss. Family members must be supportive, understanding and helpful and approach the situation in a gentle way. The hearing impaired individual may be unaware of the problem and sensitive to the idea of having a hearing loss. • - Family members are those most affected by someone’s hearing loss, with the exception of the hearing impaired person. Conversely, family members enjoy the greatest benefits when the hearing loss is treated. • - Hearing tests should be a natural and integrated part of getting a health check at the family doctor for anyone aged 40 years or older.

38. Help us (and yourself): State the facts loudly • - About half of all hearing impaired people are of working age or younger. The major reason for this is that hearing impairment occurs earlier and earlier in life, most likely because of our increased exposure to loud music noise. • - We all loose our hearing sooner or later. Hearing loss is a natural consequence of getting older. But more and more loose their hearing early in life because of exposure to loud music or other excessive noise. • - Today’s digital hearing aids are placed either inside or discreetly behind the ear. Digital hearing aids make all the difference in the quality of life for many hearing impaired people. • - Hearing aids take time getting used to, like bifocal glasses. The longer you use your hearing aids the better you’ll like them.

42. BSHAA Thank you for listening Personal, social and economic consequences of hearing loss Kim Ruberg Secretary General Hear-It AISBL

43. Consult Utilize Support www.hear-it.org BSHAA Kim Ruberg Secretary General Hear-It AISBL

44. Evaluation of costs of hearing loss Review • Very few relevant previous studies • None directly applicable • Many studies on cost effectiveness of cochlear implants

45. Previous studies • Societal costs of moderate hearing impairment • ‘The Maastricht study’ (Joore et al, 2003) • Netherlands • 80 subjects, 10 in paid employment • Considered factors which have economic impact • health related quality of life • social functioning • productivity in paid and unpaid labour • use of medical services • Concluded hearing aids are highly cost effective • Quality of life increases significantly with hearing aids

46. Previous studies • The costs of communication disorders • (USA, Ruben, 2001) • Considered losses to economy of unemployment and underemployment of people with communication disorders • hearing • voice • speech and language • Results translated into monetary values • Annual costs to US economy: $154 to $186 billion

47. Previous studies • Societal costs of severe to profound hearing loss • (USA, Mohr et al, 2003) • Very comprehensive study • Calculate lifetime costs of an individual • medical costs associated with hearing loss • special education and rehabilitation • productivity costs (reduced earnings over lifetime) • Largest component is reduced productivity • Average cost to society over lifetime of individual is $297,000 • But no account taken of psychosocial effects

48. Societal costs of severe to profound hearing loss • (Mohr et al, 2003) Previous studies

49. Previous studies • Societal costs of severe to profound hearing loss • (Mohr et al, 2003)

50. Previous studies Costs to UK of new EC Noise at Work Regulations (Health and Safety Executive, 2003) (UK Government body responsible for health and safety at work, in transport etc) • Used ‘quality of life’ approach in evaluating NIHL • Quantified reduction in quality of life (QoL) associated with degree of hearing loss • Converted reduction in QoL to monetary value assuming one full quality life year has value of £42,000 (standard UK value) • Calculated value of hearing loss over remaining working life