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Original Investigation |

Costs of Autism Spectrum Disorders in the United Kingdom and the United States

Ariane V. S. Buescher, MSc1; Zuleyha Cidav, PhD2,3; Martin Knapp, PhD1; David S. Mandell, ScD2,3
[+] Author Affiliations
1Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom
2Center for Mental Health Policy and Services Research, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
3Center for ASD Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
JAMA Pediatr. 2014;168(8):721-728. doi:10.1001/jamapediatrics.2014.210.
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Importance  The economic effect of autism spectrum disorders (ASDs) on individuals with the disorder, their families, and society as a whole is poorly understood and has not been updated in light of recent findings.

Objective  To update estimates of age-specific, direct, indirect, and lifetime societal economic costs, including new findings on indirect costs, such as individual and parental productivity costs, associated with ASDs.

Design, Setting, and Participants  A literature review was conducted of US and UK studies on individuals with ASDs and their families in October 2013 using the following keywords: age, autism spectrum disorder, prevalence, accommodation, special education, productivity loss, employment, costs, and economics. Current data on prevalence, level of functioning, and place of residence were combined with mean annual costs of services and support, opportunity costs, and productivity losses of individuals with ASDs with or without intellectual disability.

Exposure  Presence of ASDs.

Main Outcomes and Measures  Mean annual medical, nonmedical, and indirect economic costs and lifetime costs were measured for individuals with ASDs separately for individuals with and without intellectual disability in the United States and the United Kingdom.

Results  The cost of supporting an individual with an ASD and intellectual disability during his or her lifespan was $2.4 million in the United States and £1.5 million (US $2.2 million) in the United Kingdom. The cost of supporting an individual with an ASD without intellectual disability was $1.4 million in the United States and £0.92 million (US $1.4 million) in the United Kingdom. The largest cost components for children were special education services and parental productivity loss. During adulthood, residential care or supportive living accommodation and individual productivity loss contributed the highest costs. Medical costs were much higher for adults than for children.

Conclusions and Relevance  The substantial direct and indirect economic effect of ASDs emphasizes the need to continue to search for effective interventions that make best use of scarce societal resources. The distribution of economic effect across many different service systems raises questions about coordination of services and sectors. The enormous effect on families also warrants policy attention.

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