The Economic Costs of Congenital Hearing Loss in a South African Cohort

Background: The prevalence of congenital hearing loss in South Africa is estimated to be 6 per 1000 live births, which is higher than most high-income countries but consistent with rates observed in other parts of Africa. While policymakers typically focus on direct healthcare-related costs, many of the broader societal and economic impacts of congenital hearing loss remain hidden, including educational, vocational, and social consequences. Understanding the full economic burden is essential for informed policy and healthcare planning. Objectives: To assess the full economic burden of congenital hearing loss, including indirect and intangible costs in South Africa. Design: A cost-of-illness model from a societal perspective in 2022. Methods: We constructed a cohort-survival model to estimate the societal lifetime costs of congenital hearing loss. Cost components included direct medical expenses (diagnostics, devices, surgeries), non-medical costs (special education), indirect costs (lost productivity, reduced earnings) and the monetary value of disability adjusted life years lost due to hearing loss. Model inputs were derived from published literature and consultation with experts. Results: Total economic cost for the cohort was ZAR 16.4 billion (USD 1 billion per lifetime or ZAR 256 million (USD 15.9 million) per year. Productivity losses made up the largest proportion of societal costs with losses of approximately ZAR 2.4 billion (52% of total costs). Total discounted cost per person with hearing loss was ZAR 1.1 million (USD 70 thousand) per lifetime. Conclusion: Congenital hearing loss has far-reaching implications beyond immediate healthcare expenses, including significant societal and economic costs. Early childhood interventions such as newborn screening and early identification, assistive devices and speech and language therapy interventions may reduce the high costs associated with congenital hearing loss and may provide substantial returns on investment.