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Economic Costs of Autism
Martin Knapp
London School of Economics& King’s College London (IoP)
Based on research conducted withRenee Romeo & Jennifer Beecham
Our over-riding concern is how to meet personal & family needs …
So why is economics relevant?Scarcity never enough
resources to meet all of society’s needs or wants.
So … economists are asked to look carefully at:
• costs• cost-effectiveness• how to improve resource
allocation
Wh
y?
Today’s focus
1. Prevalence2. Level of functioning3. Place of residence4. Service use patterns5. Family expenses6. Lost employment7. Costs per person8. UK-wide costs9. Lifetime costsMeth
od
s
Many different prevalence estimates, growing over time …
Could be due to:• Better recognition of needs?• More accurate diagnosis?• Or underlying growth in
prevalence?Most recent study is by Gillian Baird
et al (Lancet 2006) in SE England of children aged 9-10
We have assumed prevalence of 1% of total UK population have ASDP
revale
nce
Estimated numbers of people with ASD in the UK, 2005
Age group High functioning
Low functioning
0-3 yrs 1243 1520
4-11 yrs 25,675 31,381
12-17 yrs 21,239 25,958
18+ yrs 194,737 238,013
All 242,894 296,872
The autism spectrum contains a number of different conditions or needs …
… with different behavioural characteristics,
… and different implications for support from families, formal services etc
… and hence (probably) different costsWe were hampered by lack of data and we
have simply distinguished:• low-functioning ASD (IQ<70)• high-functioning ASD (IQ>70)From Gillian Baird’s study we assumed:
55% of people with ASD are low-functioning
45% are high-functioning
Fu
ncti
on
ing
Where do people with ASD live?Again – very difficult to find any
national or even local data … so estimates made from various sources (NAS, Emerson report on people with ID, Bebbington & Beecham on Children in Need …)
Children:• All high-functioning children
live in private households• 2% of low-functioning children
are in residential care or foster placementsR
esid
en
ce
Estimated places of residence for adults with ASD (%)
High functioning
Low functioning
Private households
79% 35%
Supported housing
5% 7%
Residential care
16% 52%
Hospital - 6%
All 100% 100%
What services and supports do people with ASD receive?
We got data from:• Our own previous studies of people
with intellectual disability – looking at those with ASD – mostly from England
• Jeni Beecham’s work on Children in Need data for England
• The ONS survey of mental health problems (children) 2004, Great Britain
• A Scottish study by Anna Cooper et al• A Swedish study of HF ASD peopleWe re-grouped and inflated these data to
fit residence categories and cover UK
Serv
ices
In addition we looked at family costs:• Out-of-pocket payments for services
or treatments• Time spent on informal care … but
could not find any data• Lost income because of disrupted
employment (= lost productivity)And we also looked at:• Lost productivity for people with ASD
who were not in employmentAnd we estimated social security
benefits received – but these might ‘double-count’ some other costs
Oth
er
costs
Children with HF ASD: average annual costs (£)
0
5000
10000
15000
20000
0-3 yrs 4-11 yrs 12-17 yrs
Employ't
Treatments
Educ supp
Special ed
Respite
Other HPSS
Hospital
Adults with LF ASD: average annual costs (£)
0
25000
50000
75000
100000
Priv HH Supp P Rescare
Hospital
Treatment
Emp indiv
EmpparentsFamily
Emp supp
Adult ed
Day care
Respite
Other HPSS
Hospital
Accomm
Children – annual cost in the UKLow-functioning ASD = £1,727 mill.High-functioning ASD = £991 mill.
Adults – annual cost in the UKLow-functioning ASD = £16,907 mill.High-functioning ASD = £8,573 mill.
Costs of ASD – UK - 2005/06
Aggregate cost – for children and adults - for high-functioning and low functioning autism:
£28 billion
Overall UK cost of ASD
Someone with low-functioning ASD = £4.7 million
Someone with high-functioning ASD = £2.9 million
Lifetime cost of ASD
1. Huge overall economic impact2. Costs are widely spread across
different budgets and parts of government – need coordination
3. High costs fall to families – Is this fair? Is it sustainable?
4. High costs associated with lost employment: Can we do better to support people into jobs?
5. High costs of supporting adults with ASD can we reduce them by offering better and earlier intervention?
An
d s
o …
?
