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Stuttering and health economics (Norman et al., 2023)

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posted on 2023-09-26, 22:10 authored by Alicia Norman, Robyn Lowe, Mark Onslow, Sue O’Brian, Ann Packman, Ross Menzies, Liz Schroeder

Purpose: For those who stutter, verbal communication is typically compromised in social situations. This may attract negative responses from listeners and stigmatization by society. These have the potential to impair health-related quality of life across a range of domains, including qualitative and quantitative impacts on speech output, mental health issues, and failure to attain educational and occupational potential. These systematic reviews were designed to explore this matter using traditional health economics perspectives of utility measures and cost of illness.

Method: Studies were included if they involved children, adolescents, or adults with stuttering as a primary diagnosis. The quality of life search strategy identified 2,607 reports, of which three were included in the quality of life analysis. The cost of illness search strategy identified 3,778 reports, of which 39 were included in the cost of illness analysis.

Results: Two of the three studies included in the quality of life analysis had a high risk of bias. When measured using utility scores, quality of life for people who stutter was in the range of those reported for chronic health conditions such as diabetes mellitus, cardiovascular disease, and cancer. However, there is little such evidence of quality of life impairment during the preschool years. Studies included in the cost of illness analysis carried considerable risk of bias overall.

Conclusions: For people who stutter, there are substantive direct and indirect costs of illness. These include impairment, challenges, and distress across many domains throughout life, including income, education, employment, and social functioning. Evidence of quality of life impairment using utility measures is extremely limited. If this situation is not remedied, the lifetime impairment, challenges, and distress experienced by those who stutter cannot be documented in a form that can be used to influence health policy and health care spending.

Supplemental Material S1. Search terms.

Supplemental Material S2. Data extraction form.

Supplemental Material S3. Risk of bias for the quality of life and cost studies.

Supplemental Material S4. Summary of studies included in the cost of illness analysis.

Norman, A., Lowe, R., Onslow, M., O’Brian, S., Packman, A., Menzies, R., & Schroeder, L. (2023). Cost of illness and health-related quality of life for stuttering: Two systematic reviews. Journal of Speech, Language, and Hearing Research. Advance online publication.


This research was supported by National Health and Medical Research Council Program Grant 1132370, awarded to Mark Onslow, Ross Menzies, Ann Packman.


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