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

Abstract

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.