Spending on Young Children With Autism Spectrum Disorder in Employer-Sponsored Plans, 2011-2017

Abstract

Objective: Rapid increases in the prevalence of autism spectrum disorder (ASD) and increased access to intensive behavioral interventions have likely increased health care spending. This study estimated recent changes in spending among privately insured children with and without current ASD.

Methods: A repeated cross-sections analysis of 2011-2017 claims data from large-employer-sponsored health plans assessed changes in annual expenditures by service type for children ages 3-7 enrolled for ≥1 year and with two or more claims with ASD billing codes within a calendar year and for all other children.

Results: Mean spending per child with a current-year ASD diagnosis increased by 51% in 2017 U.S. dollars, from roughly $13,000 in 2011 to $20,000 in 2017. Among children who did not meet the current-year ASD case definition, per-child spending increased by 8%. Spending on children with ASD accounted for 41% of spending growth for children ages 3-7 during 2011-2017. Outpatient behavioral intervention-related spending per child with ASD increased by 376%, from $1,746 in 2011 to $8,317 in 2017; spending on all other services increased by 2%. Their share of behavioral intervention-related spending increased from 13.2% in 2011 to 41.7% in 2017. In 2011, 2.5% of children with current-year ASD diagnoses incurred ≥$20,000 in outpatient behavioral intervention-related spending, which increased to 14.4% in 2017.

Conclusions: During 2011-2017, spending increased six times as much for privately insured children ages 3-7 with current-year ASD as for children without ASD, largely from increased behavioral intervention-related spending. One in seven children received at least $20,000 in services in 2017.

Keywords: Autism; Economics.

FIGURE 1.

Mean expenditures on outpatient behavioral intervention–related services per child ages 3–7 with current-year autism spectrum disorder (ASD) in noncapitated large-employer plans, by procedure code type^{a a} Source: MarketScan Commercial Data, 2011–2017. Expenditures were adjusted for inflation to 2017 U.S. dollars by using the U.S. gross domestic product deflator. Adaptive behavioral procedure codes 0364T–0374T; therapeutic behavioral procedure codes H2019 and H2020; behavioral intervention–related and all other behavioral intervention–related codes listed in Table S2, part a, in online supplement.