Cost-Benefit Ratio of Auditory-Verbal Therapy

Jane Madell
October 31, 2017

Last week I had the honor of visiting London and, among other things, got to visit Auditory Verbal UK. (AVUK TM)  This is a wonderful center which has been very successful in mainstreaming children with hearing loss. One of the questions which often comes up is whether the cost of auditory-verbal therapy justifies the benefit. Those of us who work with families to get services in schools have a difficult time getting schools to pay for auditory-verbal services. How is it possible to demonstrate the value of auditory-verbal practice.

AVUK did an extensive study looking at the cost benefit ratio of providing auditory verbal therapy. Although the study was done in the UK, the results are easy to transfer to the US. The study shows that for every £1there is a £4 return. The study further shows that the earlier the intervention begins, the better the prognosis for language development and the greater the gains in areas such as quality of life, employment and productivity.

The goal of listening and spoken language – auditory-verbal practice is to develop spoken language through listening. This therapy uses technology (hearing aids and cochlear implants) to develop the auditory brain to teach language through listening. In the AVUK program, like most other programs for children with hearing loss, about 30% of the children have additional needs.


Benefits of listening and spoken language

The literature that was used for this review for this study includes

  • Research on language development shows that speech and language competency responds to early intervention
  • AVT is an early intervention that has been adopted in a number of different countries internationally
  • The earlier the intervention begins, the better the prognosis for language
  • Intensive intervention produces better outcomes
  • The proportion of children who can benefit from AVT is high
  • Benefits of early intervention include likely gains in areas such as quality of life, employment and productivity which is expected to be life-long.

The cost-benefit analysis used a 50-year projection to reflect that the majority of benefits occur later in life. Costs which are incurred in a child’s early life can be seen as an investment in the child’s future.


The costs

The study looked at costs of providing the therapy, loss of income to the family member working with the child, travel costs, and childcare for siblings. If average therapy program is about 3.5 years they reported that the value of all costs is £31,119.


The benefits

It is assumed that half the benefits are from auditory verbal therapy and half are from the use of technology. AVUK reports that the vast majority of children who complete an auditory verbal therapy program have language competency with the typical range of hearing children. Approximately 80% of children enrolled in the program for more than two years graduated with age appropriate language and most attended mainstream schools. By contrast, figures published by the National Deaf Children’s Society shows only 26% of deaf children achieve good development. Using a 50 year projected horizon, the value of therapy results in £137,799 – more than £100,000 benefit. The benefits come from improved quality of life, increased employment, higher income/productivity, lower cost of schooling, lower dependence on government support, and injuries avoided. For every £1 invested in AVT, £4 is returned.


Getting services

In the US, not every child has access to listening and spoken language services. Very few early intervention specialists and school speech-language pathologists have training in listening and spoken language. Some countries, like Australia, have a government program which provides listening and spoken language therapy to any family who chooses it. Other countries, like the US and UK have limited availability. The information available now clearly demonstrates the benefit of listening and spoken language – auditory-verbal practice. It is time that early intervention and school programs work NOW to build the skills in their communities to give children with hearing loss every opportunity.

More information on this research program can be found at 

birdsong hearing benefits

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