Three and a half decades of SLT economic evaluation - still a small, fragmented, poorly interconnected literature
How this was rated
Comprehensive scoping review with systematic search approach covering a 35-year window. Scoping reviews describe the literature rather than evaluate individual study quality in depth. The central finding - that the literature is small and disconnected - is well-supported by the data extracted.
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A scoping review of 52 economic evaluations of speech and language therapy interventions published between 1988 and 2023. The field is growing (3-5 publications a year since 2019) but remains small, methodologically heterogeneous, and poorly interconnected - only 18 of 43 studies cited another included study. No economic evaluations of VR-based SLT interventions were identified.
Commissioners asking 'is this cost-effective' about any SLT intervention - including VR - have very limited evidence to answer with. The published economic literature is thin, fragmented, and rarely addresses new intervention types. This is a genuine evidence gap, not a reassuring absence of findings.
Key findings
- 52 studies identified over 1988-2023; 44 completed, 8 protocol-only
- Publication rate increased since 2019 to 3-5 per year
- Studies concentrated in USA (31.8%), Australia (22.3%), and UK (20.5%)
- Predominant populations: children and young people (17), adult stroke (9), aphasia/dysarthria (4), head and neck cancer (4), Parkinson's disease (3)
- Poor interconnectivity: only 18 of 43 studies cited another included study
- Heterogeneity in perspectives, time horizons, and outcome measures limits cross-study synthesis
- No economic evaluations of VR-based SLT interventions were identified
Background
As services face funding pressure, the question of whether speech and language therapy is cost-effective - and which SLT interventions offer best value - has become increasingly important. Yet the economic literature in SLT has not been systematically mapped. Hill and colleagues set out to do that, identifying every economic evaluation of an SLT intervention published in 35 years.
What the researchers did
A scoping review covering 1988-2023. Studies examining cost, effectiveness, or cost-effectiveness of SLT interventions for any population were identified. Data were extracted on population, intervention type, economic evaluation method, perspective, and outcomes. Interconnectivity between studies was examined by mapping citations within the included set.
What they found
52 studies were identified (44 completed, 8 protocol-only). Most concentrated in the USA, Australia, and UK. Publication rate picked up notably after 2019 but remained modest at 3-5 per year. Children and young people, adult stroke, aphasia/dysarthria, head and neck cancer, and Parkinson’s disease were the most studied populations. Critically, only 18 of 43 studies cited another included study - meaning the field is poorly connected to itself. Methods were heterogeneous: cost-consequence analysis dominated, with fewer full cost-utility or cost-effectiveness analyzes. No economic evaluations of VR-based SLT interventions were identified.
Why this matters
This review documents an evidence gap that directly affects commissioning. When a service leader asks “is VR cost-effective in SLT,” the published answer is: unknown, and the broader SLT economic literature offers little comparative context. For honest engagement with commissioners, flagging this gap and proposing local evaluation plans is more defensible than citing weak proxies.
Limitations
Scoping reviews map rather than appraise. Non-English publications may be under-represented. The field is evolving; post-2023 publications are not included.
Implications for practice
For clinicians and service leaders: when proposing new SLT interventions - VR or otherwise - prepare for the reality that published cost-effectiveness evidence is unlikely to exist. Local evaluation (time-use, attendance, goal attainment, capacity) is often the most defensible data to present. Framing an intervention's value around participation and access, not only cost per QALY, is consistent with the editorial framing used across this site and with the current evidence base.
Implications for research
Economic evaluations should be built into RCT protocols from the outset, not added afterwards. Decision-analytic modeling techniques and shared outcome measures would enable cross-study synthesis. VR-based SLT in particular has no published economic evaluation - a clear gap for future work.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{hill2025,
author = {Hill, J. and Kulkarni, A. and Moll, D. and Meteyard, L. and Shelley, L. and Chugg, G. and Jones, G. and Benedetto, V. and Harris, C. and Doherty, A. and Harrison, J. and Clegg, A.},
title = {Economic Evaluations of Speech and Language Therapy Interventions: A Scoping Review},
journal = {International Journal of Language & Communication Disorders},
year = {2025},
doi = {10.1111/1460-6984.70091},
url = {https://withvr.app/evidence/studies/hill-2025}
}TY - JOUR
AU - Hill, J.
AU - Kulkarni, A.
AU - Moll, D.
AU - Meteyard, L.
AU - Shelley, L.
AU - Chugg, G.
AU - Jones, G.
AU - Benedetto, V.
AU - Harris, C.
AU - Doherty, A.
AU - Harrison, J.
AU - Clegg, A.
TI - Economic Evaluations of Speech and Language Therapy Interventions: A Scoping Review
JO - International Journal of Language & Communication Disorders
PY - 2025
DO - 10.1111/1460-6984.70091
UR - https://withvr.app/evidence/studies/hill-2025
ER - Know of research that should be in this hub? If a relevant peer-reviewed study is not listed here, send the reference to hello@withvr.app. The hub is kept up to date as the literature grows.
Funding & independence
JEH, VB, CH, JH, AD and AC are part-funded by the National Institute for Health and Care Research Applied Research Collaboration North-West Coast (NIHR ARC NWC). Additional funding from the Royal College of Speech and Language Therapists. No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.