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Cost-Effectiveness Analysis Comparing Pre-diagnosis Autism Spectrum Disorder (ASD)-Targeted Intervention with Ontario’s Autism Intervention Program

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Abstract

Novel management strategies for autism spectrum disorder (ASD) propose providing interventions before diagnosis. We performed a cost-effectiveness analysis comparing the costs and dependency-free life years (DFLYs) generated by pre-diagnosis intensive Early Start Denver Model (ESDM-I); pre-diagnosis parent-delivered ESDM (ESDM-PD); and the Ontario Status Quo (SQ). The analyses took government and societal perspectives to age 65. We assigned probabilities of Independent, Semi-dependent or Dependent living based on projected IQ. Costs per person (in Canadian dollars) were ascribed to each living setting. From a government perspective, the ESDM-PD produced an additional 0.17 DFLYs for $8600 less than SQ. From a societal perspective, the ESDM-I produced an additional 0.53 DFLYs for $45,000 less than SQ. Pre-diagnosis interventions targeting ASD symptoms warrant further investigation.

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Acknowledgments

Melanie Penner and Meera Rayar both received salary support through the Clinician Investigator Program and the Canada Graduate Scholarship Program. Naazish Bashir receives salary support through the Child Health Evaluative Sciences unit at the Hospital for Sick Children. The authors would like to thank Jessica Brian, Wendy Ungar, Matthew Miller, and Evdokia Anagnostou for their helpful edits. Preliminary results from this work were presented in poster form at the Institute of Health Policy, Management and Evaluation Research Day on May 7, 2014, and the University of Toronto Paediatric Research Day on May 28, 2014. Preliminary results were presented in a platform presentation at the Canadian Paediatric Society Annual Meeting on June 27, 2014.

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Author notes

  1. Melanie Penner

    Present address: Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd., Toronto, ON, M4G 1R8, Canada

Authors and Affiliations

  1. Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Suite 425, Toronto, ON, M5T 3M6, Canada

    Rebecca L. Hancock-Howard & Peter C. Coyte

  2. Post-Graduate Medical Education - Pediatric Hematology/Oncology, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada

    Meera Rayar

  3. Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St., Toronto, ON, M5G 0A4, Canada

    Melanie Penner, Meera Rayar & Naazish Bashir

  4. Integrated Services for Autism and Neurodevelopmental Disorders (ISAND), 5734 Yonge St., Suite 605, Toronto, ON, M2M 4E7, Canada

    S. Wendy Roberts

  5. Clinician Investigator Program, University of Toronto, 2366 Medical Sciences Building 1 Kings College Circle, Toronto, ON, M5S 1A8, Canada

    Melanie Penner & Meera Rayar

  6. Masters of Science Program in Health Services Research, Institute of Health Policy, Management and Evaluation, 155 College St., Toronto, ON, M5T 3M6, Canada

    Melanie Penner & Meera Rayar

  7. Doctoral Program in Health Services Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada

    Naazish Bashir

  8. Professor Emerita, Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    S. Wendy Roberts

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Correspondence to Melanie Penner.

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Penner, M., Rayar, M., Bashir, N. et al. Cost-Effectiveness Analysis Comparing Pre-diagnosis Autism Spectrum Disorder (ASD)-Targeted Intervention with Ontario’s Autism Intervention Program. J Autism Dev Disord 45, 2833–2847 (2015). https://doi.org/10.1007/s10803-015-2447-0

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