Purpose: This systematic review and meta-analysis evaluated user outcomes associated with premium versus basic hearing aids, focusing on speech understanding, sound quality, and overall performance to inform accessibility and affordability in hearing care.

Method: A comprehensive literature search across four databases was conducted using PRISMA guidelines, with inclusion criteria based on the PICOST framework. Outcomes included self-reported, behavioral , and real ear measures (REMs). Fifteen studies met inclusion criteria, comprising crossover randomized controlled trials (n = 7), one parallel randomized controlled trial (n = 1), one cross-sectional study (n = 1), two quasi-experimental studies (n = 2), and four with unspecified designs (n = 4). A total of 7,952 participants with mild to moderate hearing loss were included.

Results: Evidence did not demonstrate a consistent overall advantage for premium hearing aids. However, modest context-specific benefits were observed, particularly in self-reported outcomes such as speech understanding, listening effort, and performance in noise. Behavioral outcomes favoured premium devices in noise, mainly in controlled settings. One study reported superior REM performance for premium devices. Meta-analysis of nine studies showed no significant overall advantage, with notable variability across studies.

Conclusions: Premium hearing aids may provide context-specific benefits, but these are not consistently reflected across outcomes. Findings highlight the importance of clinical judgment and the need for standardized reporting and more ecologically valid outcome measures in future research.