Eric V. Larsson, PhD, LP, BCBA-D Autism mandates result in immediate savings

Effective treatment of autism saves money this year, not just over the child’s lifetime.

The following studies of the financial impacts of the autism treatment mandates prove that access to effective ABA reduces medical costs this year and every year.

How could this be?

Medical treatment for children with autism is far more expensive every year than is medical treatment for typical children. For example, a child with autism may not comply with daily dental care, and also not comply with dental visits. So parents will resort to hospital-based services. The bill for a teeth-cleaning procedure that requires anesthesia can be up to $10,000.

o  ABA can effectively prevent the need for such costly procedures, by training and desensitizing the child’s compliance with normal medical procedures.

o  ABA also can develop the child’s compliance with medication regimens.

o  ABA can also develop the child’s compliance with basic health routines – eating, toileting, sleep, and safety.

o  ABA can also eliminate challenging behaviors that normally would be managed by medications.

The following study shows the important immediate cost savings from enacting a mandate that gives parents access to effective ABA services.

78% of families with a child with autism reported having health care expenditures for their child for the prior 12 months.

Among these families, 54% reported expenditures of more than $500, with 34% spending more than 3% of their income.

However, families living in states that enacted legislation mandating coverage of autism services were 28% less likely to report spending more than $500 for their children’s health care costs.

And families living in states that enacted parity legislation mandating coverage of autism services were 29% less likely to report spending more than $500 for their children’s health care costs.

Parish, S., Thomas, K., Rose, R., Kilany, M., & McConville, R. (2012). State Insurance Parity

Legislation for Autism Services and Family Financial Burden. Intellectual and Developmental Disabilities. 50, 190-198.

And this is all in return for not increasing the cost of care. Traditional services in Minnesota cost $60,000 for the care of a high-utilization child. ABA services in Minnesota are estimated to cost $65,000 per year for the same child in the State of Minnesota 2013 fiscal note. The ABA services replace the traditional services for a net increase in ABA cost of $5,000. However, at the same time, the immediate savings from eliminating unnecessary medical care are at least $5,813 per year, in the following studies, resulting in a net savings to the medical system this year for the 909 children currently served in Minnesota, of $739,017.

The following national studies document the average medical costs of autism every year.

CDC, 2012:

The average annual medical costs for Medicaid-enrolled children with an ASD were $10,709 per child, which was about six times higher than costs for children without an ASD ($1,812). $8,897 more.

The average annual medical cost was $8,897 more than for a child without ASD.

Children with an ASD and none of the co-occurring conditions had average medical costs of about $7,200.Children with an ASD and ID had average medical costs of about $19,200.

Children with an ASD and epilepsy had average medical costs of about $11,900.

Children with an ASD and ADHD had average medical costs of about $9,500.

(Among children with an ASD, about half had at least one of the three commonly co-occurring conditions: ADHD, intellectual disability, or epilepsy.)

(Researchers identified children who were enrolled in the Medicaid Multi-State Databases. A total of 1,472,781 children 2 through 17 years of age were included in the study, 8,398 of whom were diagnosed with an ASD. Children with an ASD, as well as ID, ADHD, or epilepsy, were identified using the ICD-9.)

Peacock, G., Amendah, D., Ouyang, L., & Grosse, S. (2012). Autism spectrum disorders and health care expenditures: the effects of co-occurring conditions. Journal of Developmental and Behavioral Pediatrics. 33, 2-8.

CDC, 2008:

Individuals with an ASD had average medical expenditures that exceeded those without an ASD by $4,110–$6,200 per year.

On average, medical expenditures for individuals with an ASD were 4.1–6.2 times greater than for those without an ASD.

The average cost of medical expenditures for children with ASD was $5,155 every year. This was $4,155 more than for those without an ASD.

Shimabukuro, T., Grosse, S., & Rice C. (2008). Medical expenditures for children with an autism spectrum disorder in a privately insured population. Journal of Autism and Developmental Disorders. 38, 546-552. Epub 2007 Aug 10.

University of Rochester, 2006:

Children with ASD had more outpatient visits, physician visits, and medications prescribed than children in general. They spent more time during physician visits than other children. Annual expenses for children with autism spectrum disorder ($6,132) were more than for other children ($860). This was $5,272 more than for those without an ASD every year.

Liptak, G., Stuart, T., & Auinger, P. (2006). Health Care Utilization and Expenditures for Children with Autism: Data from U.S. National Samples. Journal of Autism and Developmental Disorders. 36, 871-879.

University of Michigan, 2006:

Autism prevalence among children aged 3 to 17 years was 53 per 10,000 equating to a national estimate of 324,000 children.

Children with autism had a significantly higher prevalence of depression anxiety problems (38.9% vs. 4.2%)

They also had more behavioral problems (58.9% vs. 5.2%) than children without autism. Respiratory, food, and skin allergies were more often for children with autism. Children with autism had significantly higher mean physician visits over 12 for preventive care, nonemergency care, and emergency care, and were far more likely than without autism to receive physical, occupational, therapy (76.0% vs. 6.3%),

Children with ASD were more likely to need treatment or counseling for an emotional, developmental, or behavioral problem (75.4% vs. 7.0%),

And, among those taking prescribed medication, children with ASD were more likely to be using a medication (51.4% vs. 14.5%).

(Cross-sectional analysis of the 2003 to 2004 National Survey of Children’s Health.)

Gurney, J., McPheeters, M., Davis, M. (2006). Parental Report of Health Conditions and Health Care - Use Among Children With and Without Autism: National Survey of Children’s Health. Archives of Pediatric and Adolescent Medicine, 160, 825-830.

Kaiser Foundation Research Institute (2006):

Children with autism spectrum disorders had a higher annual mean number of total clinic (5.6 vs. 2.8), pediatric (2.3 vs. 1.6), and psychiatric (2.2 vs. 0.3) outpatient visits.

A higher percentage of children with autism spectrum disorders experienced inpatient (3% vs. 1%) and outpatient (5% vs. 2%) hospitalizations.

Children with autism spectrum disorders were nearly 9 times more likely to use psychotherapeutic medications and twice as likely to use gastrointestinal agents than children without autism spectrum disorders.

Mean annual member costs for hospitalizations ($550 vs. $208), clinic visits ($1,373 vs. $540), and prescription medications ($724 vs. $96) were more than double for children with autism spectrum disorders compared with children without autism spectrum disorders.

The mean annual age- and gender-adjusted total cost per member was more than threefold higher for children with autism spectrum disorders ($2,757 vs. $892). $1,865 more.

Among the subgroup of children with other psychiatric conditions, total mean annual costs were 45% higher for children with autism spectrum disorders compared with children without autism spectrum disorders; excess costs were largely explained by the increased use of psychotherapeutic medications.

Data included all children enrolled in the Kaiser Permanente Medical Care Program in northern California between July 1, 2003, and June 30, 2004.

Croen, L., Najjar, D., Ray, G., Lotspeich, L., & Bernal, P. (2006). A Comparison of Health Care Utilization and Costs of Children With and Without Autism Spectrum Disorders in a Large Group-Model Health Plan. Pediatrics. 118;e1203-e1211.

University of Pennsylvania, 2006:

The total average annual cost of children with ASD in Medicaid receiving mental health services was $9,980.

The total average annual cost of other children in Medicaid receiving mental health services was $1,102.

Children with ASDs cost $8,878 more than children without ASDs every year.

Mandell, D., Cao, J., Ittenbach, R., & Pinto-Martin, J. (2006). Medicaid Expenditures for Children with Autistic Spectrum Disorders: 1994 to 1999. Journal of Autism and Developmental Disorders. 36, 475-485.

University of Michigan / Blue Cross Blue Shield of Michigan, 2004:

People with autism incur about $306,000 in incremental direct medical costs, implying that people with autism spend twice as much as the typical American over their lifetimes and spend 60% of those incremental direct medical costs after age 21 years.

The typical American spends about $317,000 over his or her lifetime in direct medical costs, incurring 60% of those costs after age 65 years.

People with autism cost $4,250 per year more than people without every year.

Alemayehu, B. & Warner, K. (2004). The lifetime distribution of health care costs. Health Service Research, 39, 627-642.

Other costs are also saved each year.

Harvard University, 2007:

Fathers of children with lower levels of disability were assumed to be unemployed 10% of the time (and working full-time during the remaining 90%) and mothers were assumed to be unemployed 55% of time (and were working half-time 25% of the time and full-time, 20%). Fathers of children with higher levels of disability were assumed to be unemployed20%of the time and mothers were assumed to be unemployed 60% of time (and were working half-time 30% of the time and full-time, 10%).

Ganz, M.L. (2007). The lifetime distribution of the incremental societal costs of autism. Archives of Pediatric and Adolescent Medicine, 161, 343-349.

Bank One / Northwestern University, 2004:

Once the child’s skills and living situation are more naturalized, the costs to the family are immediately reduced. For example, with untreated autism, lost productivity for parents who care for children with autism is associated not only with increased absenteeism and work limitations for an employee, but an increase in the parents’ number of health risks as well. Work disruptions caused by caregiving responsibilities result in productivity losses of $1,142 per employee per year.

Burton, W., Chen, C., Conti, D., Pransky, G., & Edington, D. (2004). Caregiving for ill dependents and its association with employee health risks and productivity. Journal of Occupational Environmental Medicine. 46, 1048-1056.