Hearing aid (HA) technology has advanced significantly, offering devices that range from basic to premium models. Premium HAs often include advanced features aimed at enhancing speech understanding and sound quality. Comparing these models is important for improving accessibility and affordability in hearing care. This systematic review and meta-analysis assessed user outcomes associated with premium versus basic HAs. A comprehensive literature search across four databases was conducted using PRISMA guidelines, with inclusion criteria based on the PICOST framework. Outcomes of interest included self-reported (SR), behavioural (B), and real ear measures (REMs). Fifteen studies met inclusion criteria, most of which were crossover RCTs (6), with others including parallel RCTs (2), cross-sectional (1), quasi-experimental (2), and unspecified designs (4). Across these studies, 7,735 participants were included. Findings showed modest differences, particularly in SR outcomes, with premium devices showing advantages in speech understanding, listening effort, and noise performance. Behavioural outcomes also favoured premium HAs in noise, though mainly in controlled settings. One study comparing REMs found premium models performed better. However, meta-analysis of nine studies suggested no significant overall advantage for premium HAs. Variability across studies was notable. While manufacturers report benefits of advanced features in white papers, current outcome measures may not fully capture real1 IHCON 2026 world differences. This highlights the value of clinical judgment in technology selection. Future research should standardize reporting of HA technology levels, consider individual user variability, and include qualitative methods to better assess how advanced features affect listening effort and user experience in everyday environments.