Cost-Effectiveness Analysis Comparing Pre-diagnosis Autism Spectrum Disorder (ASD)-Targeted Intervention with Ontario's Autism Intervention Program.

Penner et al. (2015) ran a cost study. They asked: is it cheaper to give Ontario toddlers parent-led ESDM before an autism diagnosis, or to wait and give the province's standard program after diagnosis?

They built a computer model. It used real data from earlier trials and local price lists. The model tracked costs and 'dependency-free life-years' for two ESDM paths: intensive therapist-led and parent-delivered.

Both pre-diagnosis ESDM plans saved money and added healthy years. Parent-delivered ESDM was the clear winner: it cost about $8,600 less per child and gave 0.17 extra years of independence.

Even the therapist-led pre-diagnosis plan beat the status quo, but parent delivery stretched public dollars further.

The 2024 network meta-analysis by Ouyang et al. pools 32 trials and agrees: parent ESDM, PRT, and ImPACT all help kids and teach parents to use the skills well.

Geoffray et al. (2025) seems to clash. Their new European RCT found no added developmental gain after two years of ESDM plus usual care. The difference: Geoffray gave only 12 hours a week after diagnosis; Melanie's model assumed higher, earlier dose and looked at lifelong cost, not short test scores.

Earlier work backs the savings idea. Estes et al. (2014) showed parent ESDM keeps stress flat, and Cook (2010) gave the original language gains that feed the cost model. Together they support starting ESDM early, led by parents.

If you write treatment plans or advise funders, this paper gives dollar figures. Parent coaching in ESDM before diagnosis can cut spending and lift long-term independence. Push for flexible dollars that pay parents to learn ESDM while they wait for full diagnosis—it's already in the black.