The cost-effectiveness of supported employment for adults with autism in the United Kingdom

Abstract

Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom. Thus, a decision-analytic economic model was developed, which used outcome data from the only trial that has evaluated supported employment for adults with autism in the United Kingdom. The main analysis considered intervention costs, while cost-savings associated with changes in accommodation status and National Health Service and personal social service resource use were examined in secondary analyses. Two outcome measures were used: the number of weeks in employment and the quality-adjusted life year. Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for adults with autism in the United Kingdom are cost-effective compared with standard care. Further research needs to confirm these findings.

Trends in Employment for Individuals with Autism Spectrum Disorder: a Review of the Research Literature

“…However, financial deficits of the programs continued to be a big concern. Recently, Mavranezouli et al (2013) conducted a study which specifically examined the cost-effectiveness of supported employment for adults with ASD; they found that although the initial costs were higher for these services, they were reduced over time. The authors concluded that, ultimately, supported employment is more beneficial for the individuals in all aspects, when compared to standard care.…”

Factors impacting employment for people with autism spectrum disorder: A scoping review

“…Australian adults with ASD participate in employment at a rate of 42%, in comparison to 53% of all individuals with disabilities, and 83% of individuals without disabilities (Australian Bureau of Statistics, 2009;Australian Bureau of Statistics, 2010). In the United Kingdom, 15% of adults with ASD of working age are in full-time paid employment (Mavranezouli et al, 2013;Rosenblatt, 2008), and only 34% (aged 21-48 years) have ever participated in 'some' form of employment, inclusive of independent work, self-employed or sheltered employment (Howlin et al, 2004). Similarly, in the United States 58% of young adults (aged 18-25 years) with ASD have worked for pay, and only 21% are in full-time employment (Bureau of Labor Statistics, 2013; Roux et al, 2015).…”

Cost-Effectiveness of MRI-Based Identification of Presymptomatic Autism in a High-Risk Population

“…(15) However, the QALY estimates in that study were based solely on employment status, not autism. (31) Our analysis reveals that MRI-based screening of biological siblings may be a cost-effective method for assigning behavioral treatment because the ICERs fall within commonly used WTP thresholds of $50,000 and $100,000 per QALY. (27) Providing early intervention to everyone would be more effective but significantly exceed any commonly accepted WTP thresholds, even in a high-risk population such as younger biological siblings of children with ASD.…”