Health Care Service Utilization and Cost Among Adults with Autism Spectrum Disorders in a U.S. Integrated Health Care System

Abstract

Objectives: To compare health care utilization patterns and cost among insured adults with autism spectrum disorder (ASD), adults with attention-deficit and hyperactivity disorder (ADHD), and adults with neither condition (general population [GP] controls). Method: We conducted a case-control study among adults (q18 years) who were members of Kaiser Permanente Northern California (KPNC) for at least 9 months each year from 2008 to 2012. Cases (N = 1507) were adults with an ASD diagnosis (ICD-9-CM 299.0-299.8) recorded in the electronic medical record on at least two separate occasions by December 31, 2012. Two control groups, adults with ADHD (N = 9042) defined by ICD-9-CM code 314 and GP (N = 15,070), were randomly selected and frequency matched to cases on gender and age. Health care utilization and cost data were obtained from KPNC databases for the year 2012. Results: Compared with adults with ADHD, adults with ASD had significantly higher utilization of outpatient visits for primary care (74.2% vs. 66.6%), mental health (43.3% vs. 33.2%), and laboratory services (60.9% vs. 54.4%). Hospitalizations for ambulatory care sensitive diagnoses (5.4% vs. 2.3%) were less frequent overall but more common among adults with ASD than with ADHD. Group differences were larger comparing adults with ASD with GP controls. Gynecology visits and screening for cervical cancer were significantly less common among women with ASD than among women with ADHD (35% vs. 50%) or GP (35% vs. 49%). Total annual mean healthcare costs for adults with ASD were 20% higher than costs for adults with ADHD and double costs for GP. Conclusion: Adults with ASD had significantly higher rates of utilization across most health care service areas compared with adults with ADHD or GP; however, women with ASD were significantly less likely to have gynecology visits and have screening for cervical cancer.

Ambulatory Care Sensitive Admissions in Individuals With Autism Spectrum Disorder, Intellectual Disability, and Population Controls

“…Contrary to our hypothesis, individuals in the ASD‐only cohort did not significantly differ from population controls on the rates of ACS admissions. The only studies of ACS admissions in ASD in the literature [Carbone et al, ; Zerbo et al, ] did not differentiate between those with and without ID. Our results suggest that ID status may be driving the findings of increased ACS utilization in ASD.…”

“…Additionally, when compared to typically developing children, those with ASD have higher total charges and longer length of stay for ACS admissions [Carbone et al, 2015]. A recent study in the adult population found that the proportion of adults with ACS admissions was significantly higher among those with ASD relative to those with ADHD, but a difference was not observed between adults with ASD and the general population [Zerbo et al, 2018]. The present study seeks to add to the growing body of literature on the incidence of ACS admissions in individuals with ASD.…”

Development and psychometric testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale

“…Autistic adults experience a greater number of co-occurring physical and mental health conditions than non-autistic adults (Croen et al, 2015;Fortuna et al, 2016), greater healthcare costs (Zerbo et al, 2019), higher rates of premature mortality (Hirvikoski et al, 2016), and higher inpatient mortality rates (Akobirshoev, Mitra, Dembo, & Lauer, 2020). Not surprisingly, studies have also found that autistic adults experience significant healthcare disparities, with higher reported rates of unmet healthcare needs, higher emergency department visits, lower use of preventive services, and lower ratings of patient-provider communication as compared to nonautistic adults (Nicolaidis et al, 2013).…”

Psychometric testing of a set of patient-reported instruments to assess healthcare interventions for autistic adults

“…Specifically, autistic adults have more frequent co-occurring physical and mental health conditions (Croen et al, 2015;Fortuna et al, 2016) with higher rates of premature mortality (Hirvikoski et al, 2016) and inpatient mortality (Akobirshoev, Mitra, Dembo, & Lauer, 2019). They also have greater overall healthcare utilization and costs (Zerbo et al, 2019) and higher use of the emergency department (Nicolaidis et al, 2013;Vohra, Madhavan, & Sambamoorthi, 2016), with lower use of recommended preventative services, such as Papanicolaou smears (Nicolaidis et al, 2013;Zerbo et al, 2019). Similarly, studies focused on quality of care have found that autistic adults have greater unmet healthcare needs, lower satisfaction with patient provider communication, and more barriers to care than non-autistic adults (Mason et al, 2019;Nicolaidis et al, 2013;Raymaker et al, 2017).…”