Economic burden of childhood autism spectrum disorders

Abstract

Objective: To estimate the associations between autism spectrum disorder (ASD) diagnoses and service use, caregiver time, and cost outcomes.

Methods: We used national data from the Medical Expenditure Panel Survey linked to the National Health Interview Survey and a study-specific survey to estimate the annual utilization and costs for health care, school, ASD-related therapy, family-coordinated services, as well as caregiver time in children aged 3 to 17 years, with and without parent-reported ASD. Regression analyses estimated the association between ASD diagnosis and cost, controlling for child gender, age, race/ethnicity, insurance status, household income, country region and urban/rural classification, and non-ASD-related illnesses.

Results: Children with parent-reported ASD had higher levels of health care office visits and prescription drug use compared with children without ASD (P < .05). A greater proportion of children in the ASD group used special educational services (76% vs. 7% in the control group, P < .05). After adjusting for child demographic characteristics and non-ASD-associated illnesses, ASD was associated with $3020 (95% confidence interval [CI]: $1017-$4259) higher health care costs and $14,061 (95% CI: $4390-$24,302) higher aggregate non-health care costs, including $8610 (95% CI: $6595-$10,421) higher school costs. In adjusted analyses, parents who reported that their child had ASD did not have significantly higher out-of-pocket costs or spend more time on caregiving activities compared with control parents.

Conclusions: The economic burden associated with ASD is substantial and can be measured across multiple sectors of our society. Previous analyses that focused on health care underestimated this economic burden, particularly for school systems.

Keywords: autism spectrum disorder; cost of illness; health economics.

FIGURE 1

Study inclusion flowcharts for health care and non–health care analyses.

FIGURE 2

Regression-adjusted differences in non–health care costs for children with ASD compared with children without ASD, by severity and diagnostic subgroups.*Statistically significant difference compared to children without ASD (P < .05).