Use, costs, and predictors of psychiatric healthcare services following an autism spectrum diagnosis: Population-based cohort study.
After ASD diagnosis, hospital visits fall but antipsychotic bills keep total costs high—especially when kids already use psychoactive meds.
01Research in Context
What this study did
Croteau et al. (2019) followed a whole Canadian province of people with autism for five years after diagnosis.
They counted every psychiatric hospital stay, ER trip, and drug prescription paid by public insurance.
What they found
Yearly hospital visits went down, but antipsychotic use and total dollars stayed high.
The biggest red flag for future cost was any psychoactive drug already on the chart at diagnosis.
How this fits with other research
Zhao et al. (2023) saw the same cost climb in Beijing, but showed the jump is steeper once kids become adults.
Cidav et al. (2013) found the same pattern in U.S. Medicaid: therapy dollars drop while institutional dollars rise with age.
Järbrink (2007) in Sweden added parent time to the ledger; families gave 1,000 extra hours of care each year, a cost these register studies miss.
Why it matters
If a child already takes a psychoactive drug at intake, plan for high pharmacy costs ahead.
Use the early years, when hospital use is low, to build caregiver skills and community supports.
This can cut the antipsychotic load and keep total spending flatter as the child grows.
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02At a glance
03Original abstract
A number of cross-sectional studies report extensive use of psychiatric services and high healthcare costs in autistic youths. However, little is known about how the use of these services evolves from the time of diagnosis, as children grow up. Our objectives were to investigate the use, costs, and predictors of psychiatric services following autism spectrum diagnosis. We built a cohort of 1227 newly diagnosed autism spectrum individuals identified in the Quebec (Canada) Régie de l'assurance maladie du Québec administrative database (January 1998 to December 2010). Mean number and cost per individual of psychiatric healthcare use (hospitalizations, medical visits, psychoactive drug use) were calculated yearly for 5 years following autism spectrum diagnosis. Mean number of psychiatric visits decreased over time by more than threefold (7.5 vs 2.1 visits) from year 1 to year 5, whereas psychoactive drug use increased from 16.0 to 25.2 claims. Psychiatric hospitalizations decreased during follow-up, but still represented the greatest costs per individual (CAD9820 for year 1; CAD4628 for year 5). Antipsychotics represented over 50% of drug costs. Mixed-effect model with repeated measures showed that previous psychoactive drug use was the strongest predictor of greater psychiatric healthcare cost during follow-up (odds ratio: 9.96; 95% confidence interval: 7.58-13.10). These trends contrast with guidelines advocating cautious prescribing of antipsychotics with periodical re-assessment of their benefit.
Autism : the international journal of research and practice, 2019 · doi:10.1177/1362361319840229