A descriptive cost comparison of Listening and Spoken Language - South Africa versus traditional Speech-Language Therapy as therapeutic approaches for deaf and hard-of-hearing children in South Africa.

BACKGROUND

Hearing impairment affects speech-language and academic development, creating substantial lifelong public health and economic burdens. In South Africa, early intervention typically follows either the Listening and Spoken Language-South Africa (LSL-SA) or Traditional Speech-Language Therapy (TSLT) model. Although LSL-SA demonstrates promising outcomes, limited evidence compares its costs with TSLT in low- and middle-income countries (LMICs). Such evidence is needed to inform equitable health financing and disability-inclusion policies.

AIM: This study aimed to compare the total and component costs of LSL-SA and TSLT; describe cost distribution across healthcare, education and family domains and identify barriers to accessibility and scalability.

SETTING

This study was conducted in South Africa and examined intervention pathways for children with hearing impairment.

METHODS

A comparative costing approach was used to estimate expenditures across healthcare, education, and family sectors and compare the economic implications of LSL-SA and TSLT.

RESULTS

Listening and Spoken Language-South Africa incurred higher upfront therapy and rehabilitation costs but achieved superior outcomes, with 78% of children placed in mainstream schools compared with 42% in the TSLT group. The average total cost per child was ZAR 1.08 million for LSL-SA and ZAR 1.02 million for TSLT. Healthcare accounted for 65% of LSL-SA expenditure, whereas TSLT incurred higher education costs (35%) because of greater reliance on special schooling. Overall, LSL-SA demonstrated a more favourable cost-outcome profile despite its higher initial investment.

CONCLUSION

Despite greater upfront investment, LSL-SA produced better educational outcomes and a more favourable cost-outcome profile than TSLT.

CONTRIBUTION: This study provides LMIC-specific economic evidence to inform resource allocation, disability-inclusive policies, and investment in early hearing intervention.