Economic Evaluations of Speech and Language Therapy Interventions: A Scoping Review

Abstract

Background: With constrained funding and increasing demand, the pressures on health and care services globally continue to grow. Given the challenges faced, it is imperative that services and interventions demonstrate cost-effectiveness, as well as patient/service-user and societal benefits, to maximise impact.

Research has started to explore the cost-effectiveness of Speech and Language Therapy (SLT) interventions, but little is known about this body of evidence overall. Given the increasing demand for economic information by different decision-makers, an overall understanding of the current evidence base is needed. Such an evaluation should map and assess the current evidence to identify key gaps, areas of strength, and recommendations for future economic evaluations of SLT.

Aims: To identify the extent and type of economic evaluations assessing the cost (incluidng cost-effectiveness) of Speech and Language Therapy interventions.

Methods: A scoping review was conducted identifying studies across seven key databases from date of inception to 20 October 2023. Studies were included if they assessed any type of cost of an intervention which was primarily delivered (directly or indirectly) by a Speech and Language Therapist. A narrative synthesis was undertaken and clustered around common populations of interest.

Outcomes & Results: This scoping review identified 52 studies which have been published over three and a half decades . Recently, there has been a notable increase in the number of studies, specifically cost-effectiveness and cost-utility analyses; however, there were limited internal citations and a substantial variation in populations and interventions assessed by these studies. Economic evaluations were carried out alongside various effectiveness study designs, using different units of analysis, time horizons, and perspectives.

Conclusion: Although a small number of studies have begun to explore the economic aspects of SLT, evidence in this area remains relatively scarce, highlighting the need to prioritize further economic evaluations. Given the substantial heterogeneity and limited interconnectivity within the existing evidence base, it is crucial to strategically organize and coordinate efforts to optimize future research. This strategic programme may include priority setting, national and international coordination, collaborations with funding bodies and other key stakeholders, networking, and workforce development. Future economic evaluations of SLT interventions should ideally run alongside randomised controlled trials and use decision-analytic modelling techniques to strengthen the economic evidence base.