Why it is so challenging to perform economic evaluations of interventions in autism and what to do about it

Abstract

Economic evaluation is used to determine the optimal provision of services and programs under budget constraints and to inform public and private payer funding decisions. To maximize value‐for‐money in the design and delivery of programs and services for persons with autism spectrum disorder (ASD), it's essential to generate high‐quality economic evidence to inform budget allocation. There is a paucity however, of economic evaluations of interventions for ASD. This is due in part to challenges in conducting economic evaluations in this population and the lack of guidance on suitable approaches. These challenges are related to the inherent heterogeneity of the autistic population; establishing short‐ and long‐term effectiveness; measurement of costs and the availability of valid instruments for collecting economic data; the appropriateness of outcomes for use in economic evaluation; and achieving statistical power. This commentary addresses a lack of awareness and needed guidance on these issues by discussing the challenges and providing recommendations for how economic evaluations in ASD could be improved to generate high‐quality evidence for program funding decision‐making.

Sleeping Sound Autism Spectrum Disorder (ASD): Cost-Effectiveness of a Brief Behavioural Sleep Intervention in Primary School-Aged Autistic Children

“…We used QALYs as a measure of outcome in our study, as recommended when conducting economic evaluations in autism (Tsiplova & Ungar, 2023). Although we reported parent/caregiver QALYs separately and combined those with child QALYs in the sensitivity analysis, our main analysis was based on child QALYs only, given that different instruments were used to generate QALYs (i.e., AQoL-4D and CHU9D).…”

“…To date, there is a lack of evidence on the cost-effectiveness of treatments for autistic children and adolescents (Pye et al, 2023;Sampaio et al, 2021). This may be driven by unaddressed challenges in conducting economic evaluations of autism interventions related to diversity of autism presentation, and difficulty with measuring costs and outcomes, including measurement of family effects (Tsiplova & Ungar, 2023). Given the paucity of cost-effectiveness evidence in general, the Lancet Commission on the future of care and clinical research in autism has recently highlighted the need for more health economic analysis (Lord et al, 2022).…”