A cost analysis of speech-language pathology applications for telepractice during the COVID-19 pandemic

Cleft lip and palate are common congenital anomalies that impose significant healthcare and economic burdens. The COVID-19 pandemic disrupted conventional speech-language therapy, necessitating the use of telepractice interventions. The Application for Articulation Therapy-Thai (AAT-T) was developed to address these limitations. This study aimed to estimate the economic costs and resource use associated with delivering AAT-T during the pandemic. A descriptive micro-costing analysis was conducted using retrospective data from a clinical efficacy trial of AAT-T performed between May and October 2022 at Srinagarind Hospital, Thailand. Costs were estimated from a societal perspective and included direct medical costs, direct non-medical costs, and indirect costs related to caregiver productivity loss and informal care. Costs were reported in Thai baht (THB) at 2022 prices. A generalized linear model with a gamma distribution and log-link function was used to examine factors associated with variations in total costs. Eighteen children with CP ± L were included in the analysis. The mean total societal cost per child was THB 28,928.36 (95% CI: 24,442.87–33,413.85). Direct non-medical costs accounted for the largest proportion of total costs (45.28%), primarily driven by transportation expenses. Direct medical costs represented 31.99% of total costs, while indirect costs related to caregiver productivity loss and informal care accounted for 22.73%. Regression analysis showed that child age was significantly associated with higher total costs, with each additional year of age associated with an approximately 10% increase in expected costs (cost ratio: 1.10; 95% CI: 1.02–1.18; p = 0.02). Telepractice-based speech-language therapy using AAT-T appears to be a feasible service delivery approach during public health emergencies and may help address geographic and caregiver-related barriers to care for children with CP ± L in Thailand. Nevertheless, direct non-medical and indirect costs remain substantial, underscoring the importance of accounting for family and caregiver burden in health service planning. Further research is required to evaluate the clinical effectiveness, efficiency, and scalability of AAT-T in post-emergency settings before consideration of broader integration into routine speech-language therapy services.