Health Care Costs Associated with Autism among Privately Insured Children
- Presenter:
Chair: Michael Grossman; Discussant: Laura Dunlap Mon June 5, 2006 10:45-12:15 Room 309
Rationale: Costs associated with the treatment of autism and other autism-spectrum disorders (ASDs) are largely unknown, but are likely considerable. If public and private health insurance programs are not designed so that coverage for individuals with ASDs is appropriate, access to care for these patients may be compromised.
Objectives: The objective of this paper is to compute health care cost estimates for children with autism, and to compare the costs associated with autism to those of other mental health disorders among children.
Methodology: Data for the study come from the MarketScan database, which includes private health insurance claims data for over 2.5 million covered lives across the U.S. Data for calendar years 2000 through 2003 were included in the analyses. Individuals aged 17 and under with a diagnosis of autism (ICD-9 code 299.0x) or any ASD (ICD-9 codes 299.0x, 299.1x or 299.8x) were identified, and costs of all health care services were calculated. In addition to total health care costs, costs associated with inpatient, outpatient and prescription drug care were also computed. Costs were also computed for children with other mental health disorders and compared with those for autism. Costs were adjusted for inflation using the medical care component of the consumer price index.
Results: The average total annual cost per autism patient ranged from $2,468 in 2000 to $3,562 in 2002, and among patients with any ASD ranged from $2,211 in 2000 to $3,133 in 2003. On average, approximately 3.5% of patients with autism or any ASD had an inpatient stay during the year. Most patients received outpatient or pharmacy care (96% and 83% on average, respectively). Inpatient costs among hospitalized autism patients averaged $9,927 per treated patient, but varied considerably over the period. Average outpatient and pharmacy costs for autism patients were more stable over time, and averaged $1,533 and $1,414 per treated patient over the period, respectively. In general, costs associated with autism or ASDs increased over the period. Costs associated with autism or ASDs were generally higher than those for other mental health disorders, although outpatient costs per treated patient were generally lower. The lower outpatient costs may be due to the fact that many patients with ASDs receive services through the school system, whereas patients with other mental health disorders may not.
Conclusions: These data suggest that ASDs are among the more costly mental health disorders in privately insured children, and are increasing over time. Given that the prevalence of ASDs is also increasing over time, it is clear that autism is an expensive disorder. It is important to note that the data presented in this study reflect only paid health care claims. To the extent that health insurance benefits for patients with autism are more limited than they are for other mental health conditions, as some studies suggest, these results likely underestimate the costs associated with ASDs relative to other disorders.
