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Cost benefit Analyses of behavioral intervention

Page history last edited by Regina Claypool-Frey 14 years ago


Note: 5/16/10 - Note to update this in Summer 2010 to add new references.


DISCLAIMER: The information on this site is presented on an "as is" basis, and does not claim to present definitive information, make recommendation or to represent any official body or organization. Users of this site agree that the owner of the site or authors of pages and articles are indemnified against legal liability 



Counterpoint and arguments that might be framed against specific cost-benefit analyses

To avoid being taken by surprise and being able to formulate a defensive strategy.


ABA not experimental or investigational




Updated for 2009 Arguments in Support of Private Insurance Coverage of Autism-Related Services:

Eight arguments in justification for autism reform legislation. 23 pages. February 2009.

Autism Speaks/Autism Votes. 1990 K Street NW, Washington, DC 20006.



Actuarial reports


Autism Spectrum Disorders Mandated Benefits Review Panel Report: Evidence Submitted Concerning Pennsylvania HB 1150.

Durham, NC: Abt Associates, Inc., June 18, 2008.

Panel Members: Michael Ganz, Ph.D., Lisa Lavange, Ph.D., Donna Mauch, Ph.D., Joseph Morrissey, Ph.D., Chris Pashos, Ph.D., William Schlenger, Ph.D., Linmarie Sikich, M.D.

NB Applicable to all states.

From Autism Votes 

"Report Summary Conclusion: “The evidence submitted to the Pennsylvania Health Care Cost Containment Commission is sufficient to evaluate the impact of the HB 1150 mandate. The analyses and research papers support a finding of marginal premium increase costs of approximately $1 PM/PM attributable to the ASD benefit. These cost increases are modest relative to: ongoing insurance cost increases; estimated cost offsets for families and the Commonwealth; and better results for children and youth with ASD. The clinical and cost effectiveness research studies provided indicate that improvements in clinical and role functioning and quality of life can be anticipated for those children and youth with ASD who use evidence based behavioral therapies, including Applied Behavioral Analysis.”


A ctuarial Cost Estimate: Connecticut Senate Bill 301

An Act Concerning Health Insurance Coverage for Autism Spectrum Disorders

Oliver Wyman Actuarial Consulting, Inc., Marc lambright, FSA, MAAA

Fr om Autism Votes


Actuarial Cost Estimate: Georgia Senate Bill 161 An Act Relating to Insurance Coverage for Autism

Oliver Wyman Actuarial Consulting, Inc., Marc Lambright, FSA, MAAA, March 2, 2009

Fr om Autism Votes


Actuarial Cost Estimate: Kansas Senate Bill 12 An Act Relating to Insurance Coverage for Autism

Oliver Wyman Actuarial Consulting, Inc., Marc Lambright, FSA, MAAA, March 2, 2009


Fr om Autism Votes


Actuarial Cost Estimate: Missouri Senate Bill 167 – An Act Relating to Coverage for the Diagnosis and Treatment of Autism Spectrum Disorders

Oliver Wyman Actuarial Consulting, Inc., Marc lambright, FSA, MAAA.

Fr om Autism Votes



Actuarial Cost Estimate: Utah Senate Bill 43 - Coverage for the Diagnosis and Treatment of Autism Spectrum Disorder.

Oliver Wyman Actuarial Consulting, Inc., Marc lambright, FSA, MAAA. January 30, 2009.

Fr om Autism Votes


Actuarial Cost Estimate: Virginia House Bill 1588 - Coverage for the Diagnosis and Treatment of Autism Spectrum Disorder.

Oliver Wyman Actuarial Consulting, Inc., Marc lambright, FSA, MAAA. January 30, 2009.

From Autism Votes


Actuarial Cost Estimate: Washington Senate Bill 5203: An Act Relating to Insurance Coverage for Autism Spectrum Disorders.

Oliver Wyman Actuarial Consulting, Inc., Marc Lambright, FSA, MAAA, February 19, 2009

From Autism Votes


Research papers on cost-benefit analysis of EIBI & ABA


Bouder, J. N., Spielman, S., & Mandell, D. S. (2009). Brief report: Quantifying the impact of autism coverage on insurance premiums. Journal of Autism and Developmental Disorders, 1573-3432 (Online)

DOI: 10.1007/s10803-009-0701-z 


"Many states are considering legislation requiring private insurance companies to pay for autism-related services. Arguments against mandates include that they will result in higher premiums. Using Pennsylvania legislation as an example, which proposed covering services up to $36,000 per year for individuals less than 21 years of age, this paper estimates potential premium increases. The estimate relies on autism treated prevalence, the number of individuals insured by affected plans, mean annual autism expenditures, administrative costs, medical loss ratio, and total insurer revenue. Current treated prevalence and expenditures suggests that premium increases would approximate 1%, with a lower bound of 0.19% and an upper bound of 2.31%. Policy makers can use these results to assess the cost-effectiveness of similar legislation. " 

Commented on at,

Autism Research Blog: Translating Autism

"Autism coverage and insurance premiums"

Friday, February 27, 2009

http://www.translat ingautism. com/2009/ 02/autism- coverage- and-insurance- premiums. html



Chasson, G. S., Harris, G. E., & Neely, W. J. (2007). Cost comparison of early intensive behavioral Intervention and special education for children with autism. Journal of Child and Family Studies, 16(3), 401-413.

DOI: 10.1007/s10826-006-9094-1


The Costs and Benefits of Earlier Identification and Effective Intervention: Final Report. Ivy Papps, Alan Dyson, Research Report No. 505, Department for Education and Skills. Tecis LTD, 2004.



Ganz ML. The costs of autism. In: Moldin SO, Rubenstein JLR, (Eds.) Understanding Autism: From Basic Neuroscience to Treatment. Boca Raton, Fla: Taylor and Francis Group; 2006.


Ganz, M.L. (2007). The lifetime distribution of the incremental societal costs of autism

Archives of Pediatric and Adolescent Medicine, 161, 343-349.



Objective: To describe the age-specific and lifetime incremental societal costs of autism in the United States.

Design: Estimates of use and costs of direct medical and nonmedical care were obtained from a literature review and database analysis. A human capital approach was used to estimate lost productivity. These costs were projected across the life span, and discounted incremental age-specific costs were computed.

Setting: United States.

Participants: Hypothetical incident autism cohort born in 2000 and diagnosed in 2003.

Main Outcome Measures: Discounted per capita incremental societal costs.

Results: The lifetime per capita incremental societal cost of autism is $3.2 million. Lost productivity and adult care are the largest components of costs. The distribution of costs over the life span varies by cost category.

Conclusions: Although autism is typically thought of as a disorder of childhood, its costs can be felt well into adulthood. The substantial costs resulting from adult care and lost productivity of both individuals with autism and their parents have important implications for those aging members of the baby boom generation approaching retirement, including large financial burdens affecting not only those families but also potentially society in general. These results may imply that physicians and other care professionals should consider recommending that parents of children with autism seek financial counseling to help plan for the transition into adulthood.


Hildebrand DG. Cost-benefit analysis of Lovaas treatment for autism and autism spectrum disorder (ASD).

Vancouver, British Columbia: Columbia Pacific Consulting; 1999.


Jarbrink, K., Fombonne, E., & Knapp, M. (2003). Measuring the Parental, Service and Cost Impacts of Children with Autistic Spectrum Disorder: A Pilot Study. Journal of Autism and Developmental Disorders, 33(4), 395-402.

DOI: 10.1023/A:1025058711465


Jensen, V. K., & Sinclair, L. V. (2002). Treatment of autism in young children: Behavioral intervention and applied behavior analysis. Infants & Young Children, 14(4), 42-52.


Jacobson, J. W., Mulick, J. A. (2000). System and cost research issues in treatments for people with autistic disorders, Journal of Autism and Developmental Disorders, 30(6), 585-593.


Jacobson J. W., Mulick J.A., & Green G. (1998). Cost-benefit estimates for early intensive behavioral intervention for young children with autism:

General model and single state caseBehavioral Interventions, 13(4), 201-226. 



Clinical research and public policy reviews that have emerged in the past several years now make it possible to estimate the cost-benefits of early intervention for infants, toddlers, and preschoolers with autism or pervasive development disorder - not otherwise specified (PDD - NOS). Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDD - NOS can attain intellectual, academic, communication, social, and daily living skills within the normal range. Representative costs from Pennsylvania, including costs for educational and adult developmental disability services, are applied in a cost-benefit model, assuming average participation in early intensive behavioral intervention (EIBI) for three years between the age of 2 years and school entry. The model applied assumes a range of EIBI effects, with some children ultimately participating in regular education without supports, some in special education, and some in intensive special education. At varying rates of effectiveness and in constant dollars, this model estimates that cost savings range from $187,000 to $203,000 per child for ages 3-22 years, and from $656,000 to $1,082,000 per child for ages 3-55 years. Differences in initial costs of $33,000 and $50,000 per year for EIBI have a modest impact on cost-benefit balance, but are greatly outweighed by estimated savings. The analysis indicates that significant cost-aversion or cost-avoidance may be possible with EIBI.


Järbrink K, & Knapp M. (2001). The economic impact of autism in Britain. Autism, 5, 7-22.


Little is known about the economic impact of autism. This study estimated the economic consequences of autism in the United Kingdom, based on published evidence and on the reanalysis of data holdings at the Centre for the Economics of Mental Health (CEMH). With an assumed prevalence of 5 per 10,000 (1 per 2000) , the annual societal cost for the UK was estimated to exceed £1 billion. The lifetime cost for a person with autism exceeded £2.4 million. The main costs were for living support and day activities. Family costs account for only 2.3 percent of the total cost, but a lack of relevant information limited our ability to estimate these costs. Minor improvements in life outcome for people with autism could substantially reduce costs over the lifetime.


Maltby J. (2000).The costs of autism: more than meets the eye. Advocate, 33(6),12-16.


Motiwala, S. S., Gupta, S., & Lilly, M. B. (2006). The cost-effectiveness of expanding intensive behavioural intervention to all autistic children in Ontario [Canada]. Healthcare Policy, 1(2), 135-151.




Related papers on health care utilization for children with autism


Liptak, G.S., Stuart, T., & Auinger, P. (2006). Health care utilization and expenditures for children with autism.

Journal of Autism and Developmental Disorders, 36, 871-879.


Mandell, D.S., 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(4), 475-485.

DOI: 0.1007/s10803-006-0088-z


Mandell, D.S. (2007). Psychiatric hospitalization among children with autism spectrum disorders.

Journal of Autism and Developmental Disorders, Online paper


Shimabukuro, T.T., Grosse, S.D., & Rice, C. (2007). Medical expenditures for children with an autism spectrum disorder in a privately insured population.

Journal of Autism and Developmental Disorders, 38, 546-552.





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