Hill James, Kulkarni Amit, Moll Deborah, Meteyard Lotte, Shelley Louise, Chugg Grace, Jones Gemma, Benedetto Valerio, Harris Catherine, Doherty Alison, Harrison Joanna, Clegg Andrew
Applied Health Research hub, University of Central Lancashire and Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, NIHR Applied Research Collaboration North-West Coast (ARC NWC), Preston, UK.
Royal College of Speech & Language Therapists, London, UK.
Int J Lang Commun Disord. 2025 Jul-Aug;60(4):e70091. doi: 10.1111/1460-6984.70091.
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 maximize 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.
To identify the extent and type of economic evaluations assessing the cost (including cost-effectiveness) of SLT interventions.
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, including adults post-stroke, adults with aphasia or dysarthria, adults with Parkinson's disease, adults with head and neck cancer, and children, young people, and adults with a range of conditions.
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.
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. Future economic evaluations of SLT interventions should ideally run alongside randomized controlled trials and use decision-analytic modelling techniques to strengthen the economic evidence base.
What is already known on the subject As pressures grow on health and social care services, it is increasingly important that the care and support provided is shown to be both effective and cost-effective, informing those who plan, provide, receive and pay for the services. Although some research has begun to examine the cost-effectiveness of speech and language therapy (SLT) interventions, the overall extent and depth of this body of evidence remain unknown. What this study adds to the existing knowledge This scoping review offers an overview of the maturity, depth, and extent of the evidence assessing the costs and cost-effectiveness of interventions provided by SLT. Although the evidence base continues to grow, it appears to lack coherence in its development, necessitating a strategically planned approach to optimize and coordinate efforts to the benefit of the service and those using it. What are the potential or clinical implications of this work? This scoping review has identified 52 studies which assessed the cost of SLT. The evidence from these studies can help us better understand the economic value of SLT. However, given the relative immaturity of the evidence base and lack of coordination across the findings, further research is required. This research should draw from the findings of this review and would ideally be part of a coherent, coordinated effort to develop a full understanding of the economic value of SLT across different clinical areas.
在资金受限和需求不断增加的情况下，全球卫生和护理服务面临的压力持续增大。鉴于所面临的挑战，服务和干预措施必须证明具有成本效益以及对患者/服务使用者和社会的益处，以实现最大影响。研究已开始探索言语和语言治疗（SLT）干预措施的成本效益，但总体而言，对这一证据体系了解甚少。鉴于不同决策者对经济信息的需求不断增加，需要对当前的证据基础有全面的了解。这样的评估应梳理和评估现有证据，以确定关键差距、优势领域以及对SLT未来经济评估的建议。
确定评估SLT干预措施成本（包括成本效益）的经济评估的范围和类型。
进行了一项范围综述，检索了从数据库建立之日至2023年10月20日期间七个主要数据库中的研究。如果研究评估了主要由言语和语言治疗师直接或间接提供的任何类型干预措施的成本，则纳入该研究。进行了叙述性综合分析，并围绕共同感兴趣的人群进行聚类，包括中风后成年人、失语或构音障碍成年人、帕金森病成年人、头颈癌成年人以及患有一系列疾病的儿童、青少年和成年人。
本范围综述确定了35年多来发表的52项研究。最近，研究数量显著增加，特别是成本效益分析和成本效用分析；然而，内部引用有限，这些研究评估的人群和干预措施存在很大差异。经济评估是在各种有效性研究设计的同时进行的，使用了不同的分析单位、时间范围和视角。
尽管少数研究已开始探索SLT的经济方面，但该领域的证据仍然相对较少，这凸显了进一步进行经济评估的必要性。鉴于现有证据基础存在很大异质性且相互关联性有限，战略性地组织和协调工作以优化未来研究至关重要。SLT干预措施的未来经济评估理想情况下应与随机对照试验同时进行，并使用决策分析建模技术来加强经济证据基础。
关于该主题的已知信息随着卫生和社会护理服务压力的增加，所提供的护理和支持既有效又具有成本效益变得越来越重要，这为规划、提供、接受和支付服务的人员提供了信息。尽管一些研究已开始研究言语和语言治疗（SLT）干预措施的成本效益，但这一证据体系的总体范围和深度仍然未知。本研究对现有知识的补充本范围综述概述了评估SLT提供的干预措施成本和成本效益的证据的成熟度、深度和范围。尽管证据基础在不断扩大，但它在发展过程中似乎缺乏连贯性，因此需要采取战略规划的方法来优化和协调工作，以造福服务及其使用者。这项工作的潜在或临床意义是什么？本范围综述确定了52项评估SLT成本的研究。这些研究的证据可以帮助我们更好地理解SLT的经济价值。然而，鉴于证据基础相对不成熟且研究结果缺乏协调性，需要进一步研究。这项研究应借鉴本综述的结果，理想情况下应成为一项连贯、协调努力的一部分，以全面了解SLT在不同临床领域的经济价值。
