Abstract
Biological siblings of children with autism spectrum disorder (ASD) have increased risk of receiving an ASD diagnosis. In the U.S., most children with ASD are diagnosed after the optimal age to initiate early intervention which can reduce symptom severity and improve outcomes. Recent evidence suggests magnetic resonance imaging (MRI) in the first year of life can predict later diagnostic status in high-risk siblings. We investigated whether MRI-based screening is a cost-effective method for assigning early intervention. A hybrid decision tree/Markov model was used to evaluate two MRI-based screening strategies at 6 and 12 months of age. Primary outcomes were costs in U.S. dollars and quality-adjusted life years (QALYs). Results were reported as incremental cost-effectiveness ratios (ICERs). Costs were estimated from societal, health care, and educational perspectives. One-way and probabilistic sensitivity analyses were performed. From a societal perspective, the ICER for MRI-based screening at 6 months was $49,000 per QALY when compared to the status quo, implying that such screening is cost-effective at willingness-to-pay (WTP) thresholds of $50,000–$100,000 per QALY. From the health care and educational perspectives, the ICERs were larger at $99,000 and $76,000 per QALY, respectively. Sensitivity analysis identified that the parameters most influential in affecting cost-effectiveness were the prevalence of ASD and/or co-occurring intellectual disability. MRI specificity also has significant impacts which add to the uncertainty of the results. Future work is needed to determine the sensitivity and, in particular, the specificity of MRI with more certainty. Notably, the cost of the MRI-based screening had the least impact.
Highlights
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired social–communication skills and the presence of restricted and repetitive behavior
Early intervention is measurably helpful in meeting these challenges. This study quantifies these effects by examining the cost-effectiveness of implementing magnetic resonance imaging (MRI) in the first year of life to augment early identification of risk and accelerate entry into intensive behavioral interventions
(6) Early intensive behavioral intervention (EIBI), assumed to be initiated before age 4—a time of rapid development and substantial brain plasticity—can produce significant longterm gains in social, cognitive, and language development. [7,8,9] autism spectrum disorder (ASD) can be reliably diagnosed earlier, the median age of diagnosis in the U.S is 50 months of age. [1, 6] As a consequence, more than half of U.S children with the disorder are diagnosed after age 4, too late to receive the full benefits of early intervention, while even those diagnosed prior to age 4 often experience significant delays in treatment. [10, 11] Improving early identification of ASD increases opportunities for early intervention
Summary
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired social–communication skills and the presence of restricted and repetitive behavior. Cost-Effectiveness of MRI Screening for ASD early intervention is measurably helpful in meeting these challenges. This study quantifies these effects by examining the cost-effectiveness of implementing magnetic resonance imaging (MRI) in the first year of life to augment early identification of risk and accelerate entry into intensive behavioral interventions. Two reports, using MRI at 6 and 12 months of age, predict with greater than 80% accuracy whether high-risk infant siblings of children with autism will subsequently meet diagnostic criteria for ASD at age 24 months. [12, 13] These findings raise the possibility of prodromal or presymptomatic identification of ASD among children at high risk and prompt an essential public health question: Is it cost-effective to identify and assign treatment based on early MRI screening? Prevalence estimates of ASD in the United States range from one in 59 in the general population to one in five for children with older siblings diagnosed with ASD. [1,2,3] The lifetime cost, including housing, special education, and productivity loss, of supporting an individual with ASD, compared to those without it, is estimated at between $1.4 and $2.4 million. [4] Total costs in the U.S may exceed $1 trillion annually by 2025. [5] Reliable early diagnoses of ASD can be made between 18 and 36 months of age. [6] Early intensive behavioral intervention (EIBI), assumed to be initiated before age 4—a time of rapid development and substantial brain plasticity—can produce significant longterm gains in social, cognitive, and language development. [7,8,9] ASD can be reliably diagnosed earlier, the median age of diagnosis in the U.S is 50 months of age. [1, 6] As a consequence, more than half of U.S children with the disorder are diagnosed after age 4, too late to receive the full benefits of early intervention, while even those diagnosed prior to age 4 often experience significant delays in treatment. [10, 11] Improving early identification of ASD increases opportunities for early intervention.
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