Estimated Therapy Costs and Downstream Cost Consequences of iBASIS–Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia

This publication is included in the Autistic Autism Scholarship Project. one author of this publication is identified as autistic in the project.

About the autistic author marker

Metadata sources used for this reference

OpenAlex Crossref OpenCitations
Learn more about the sources used

Segal, L., Green, J., Twizeyemariya, A., Hudry, K., Wan, M. W., Barbaro, J., Iacono, T., Varcin, K. J., Pillar, S., Cooper, M. N., Billingham, W., Upson, G., & Whitehouse, A. (2023). Estimated Therapy Costs and Downstream Cost Consequences of iBASIS–Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia. JAMA Network Open, 6(4), e235847. https://doi.org/10.1001/jamanetworkopen.2023.5847

Publication date: 5 Apr 2023 Added to AutiHub: 7 Sep 2026 Type: Article Article language: English
Publisher source (DOI) Full text OpenAlex source

This publication is integrated into AutiHub through:

Authors

Publication authors
13
Publication authors identified as autistic
1 / 13 (7.7%)
  1. Leonie Segal
  2. Jonathan Green
  3. Asterie Twizeyemariya
  4. Kristelle Hudry
  5. Ming Wai Wan
  1. Josephine Barbaro *
  2. Teresa Iacono
  3. Kandice J Varcin
  4. Sarah Pillar
  5. Matthew N Cooper
  1. Wesley Billingham
  2. Gemma Upson
  3. Andrew Whitehouse

Abstract

Importance The growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant. Objective To estimate the net cost impact of the iBASIS–Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government. Design, Setting, and Participants Infants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023. Exposures iBASIS-VIPP intervention. Main Outcomes and Measures To project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings. Results Of the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer. Conclusions and Relevance The results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 12 Sep 2026 17:34.

Cited references
52
With a DOI
40
Without a DOI, from raw bibliography text
10
5 / 52 (9.6%) cited references include at least one author identified as autistic.
References with data to complete
11 / 52 (21.2%)
References with detected author names
42 / 52 (80.8%)
Without detected author names
10
Without a structured title
11
Without a stable identifier
10
References with raw author names still to review
10
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
269
From DOI or external metadata
269
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
10
142 / 269 (52.8%) names are linked to an author already present in AutiHub. 127 / 269 (47.2%) names are not yet linked.
Names linked to a person identified as autistic
5 / 269 (1.9%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 5 / 142 (3.5%). Distinct people identified as autistic: 2 / 194 (1.0%).
  2. Mason (2018). Predictors of quality of life for autistic adults. Autism Research, 11(8), 1138. Wiley.
    Type: Other DOI: 10.1002/aur.2018.11.issue-8 OpenAlex: https://openalex.org/W4251893290
    Crossref OpenAlex OpenCitations
  3. Elizabeth Shephard , Bosiljka Milosavljevic , Greg Pasco , Emily JH Jones , Teodora Gliga , Francesca Happé et al. (2017). Mid‐childhood outcomes of infant siblings at familial high‐risk of autism spectrum disorder . Autism Research, 10(3), 546-557. Wiley.
    Type: Article DOI: 10.1002/aur.1733 OpenAlex: https://openalex.org/W2558723311
    OpenAlex OpenCitations
  4. The BASIS Team , Jonathan Green , Ming Wai Wan , Jeanne Guiraud , Samina Holsgrove , Janet McNally et al. (2013). Intervention for Infants at Risk of Developing Autism: A Case Series . Journal of Autism and Developmental Disorders, 43(11), 2502-2514. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-013-1797-8 OpenAlex: https://openalex.org/W1997944106
    Crossref OpenAlex OpenCitations
  5. Barbara FC van Heijst , Hilde M. Geurts (2015). Quality of life in autism across the lifespan: A meta-analysis . Autism, 19(2), 158-167. SAGE Publications.
    Type: Article DOI: 10.1177/1362361313517053 OpenAlex: https://openalex.org/W2150681219
    Crossref OpenAlex OpenCitations
  6. Xiaoli Liao , Yamin Li (2020). Economic burdens on parents of children with autism: a literature review . CNS Spectrums, 25(4), 468-474. Cambridge University Press (CUP).
    Type: Article DOI: 10.1017/s1092852919001512 OpenAlex: https://openalex.org/W2987978580
    Crossref OpenAlex OpenCitations
  7. Thomas R. Insel (2014). Mental Disorders in Childhood . JAMA, 311(17), 1727. American Medical Association (AMA).
    Type: Article DOI: 10.1001/jama.2014.1193 OpenAlex: https://openalex.org/W2014276259
    Crossref OpenAlex OpenCitations
  8. Andrew Whitehouse , Helen J. Watt , E. A. Line , Dorothy V. M. Bishop (2009). Adult psychosocial outcomes of children with specific language impairment, pragmatic language impairment and autism . International Journal of Language & Communication Disorders, 44(4), 511-528. Wiley.
    Type: Article DOI: 10.1080/13682820802708098 OpenAlex: https://openalex.org/W2088359266
    Crossref OpenAlex OpenCitations
  9. Zuleyha Cidav , Jeff Munson , Annette Estes , Géraldine Dawson , Sally J. Rogers , DAVID S. MANDELL (2017). Cost Offset Associated With Early Start Denver Model for Children With Autism . Journal of the American Academy of Child & Adolescent Psychiatry, 56(9), 777-783. Elsevier BV.
    Type: Article DOI: 10.1016/j.jaac.2017.06.007 OpenAlex: https://openalex.org/W2729652352
    Crossref OpenAlex OpenCitations
  10. Flavia Chiarotti , Aldina Venerosi (2020). Epidemiology of Autism Spectrum Disorders: A Review of Worldwide Prevalence Estimates Since 2014 . Brain Sciences, 10(5), 274. MDPI AG.
    Type: Article DOI: 10.3390/brainsci10050274 OpenAlex: https://openalex.org/W3023295472
    Crossref OpenAlex OpenCitations
  12. Patty Leijten , Maartje A. J. Raaijmakers , Bram Orobio de Castro , Walter Matthys (2013). Does Socioeconomic Status Matter? A Meta-Analysis on Parent Training Effectiveness for Disruptive Child Behavior . Journal of Clinical Child & Adolescent Psychology, 42(3), 384-392. Informa UK Limited.
    Type: Article DOI: 10.1080/15374416.2013.769169 OpenAlex: https://openalex.org/W2098754246
    Crossref OpenAlex OpenCitations
  13. Zhen Li , Lejin Yang , Hui Chen , Yuan Fang , Tongchao Zhang , Xiaolin Yin et al. (2022). Global, regional and national burden of autism spectrum disorder from 1990 to 2019: results from the Global Burden of Disease Study 2019 . Epidemiology and Psychiatric Sciences, 31, e33-e33. Cambridge University Press (CUP).
    Type: Article DOI: 10.1017/s2045796022000178 OpenAlex: https://openalex.org/W4280591091
    Crossref OpenAlex OpenCitations
  15. Jonathan Green , Tony Charman , Helen McConachie , Catherine Aldred , Vicky Slonims , Patricia Howlin et al. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial . The Lancet, 375(9732), 2152-2160. Elsevier BV.
    Type: Article DOI: 10.1016/s0140-6736(10)60587-9 OpenAlex: https://openalex.org/W2099484012
    Crossref OpenAlex OpenCitations
  16. A. J. Baxter , Traolach Brugha , H. E. Erskine , R. W. Scheurer , T. Vos , J. G. Scott (2015). The epidemiology and global burden of autism spectrum disorders . Psychological Medicine, 45(3), 601-613. Cambridge University Press (CUP).
    Type: Article DOI: 10.1017/s003329171400172x OpenAlex: https://openalex.org/W2171607710
    Crossref OpenAlex OpenCitations
  17. Rebecca Sutherland , David Trembath , Jacqueline Roberts (2018). Telehealth and autism: A systematic search and review of the literature . International Journal of Speech-Language Pathology, 20(3), 324-336. Informa UK Limited.
    Type: Article DOI: 10.1080/17549507.2018.1465123 OpenAlex: https://openalex.org/W2802741593
    Crossref OpenAlex OpenCitations
  18. Martin Knapp , Renée Romeo , Jennifer Beecham (2009). Economic cost of autism in the UK . Autism, 13(3), 317-336. SAGE Publications.
    Type: Article DOI: 10.1177/1362361309104246 OpenAlex: https://openalex.org/W2099729797
    Crossref OpenAlex OpenCitations
  19. Eleni Vasilopoulou , Joy Nisbet (2016). The quality of life of parents of children with autism spectrum disorder: A systematic review . Research in Autism Spectrum Disorders, 23, 36-49. Elsevier BV.
    Type: Article DOI: 10.1016/j.rasd.2015.11.008 OpenAlex: https://openalex.org/W2219154285
    Crossref OpenAlex OpenCitations
  20. Thomas R. Insel (2007). The arrival of preemptive psychiatry . Early Intervention in Psychiatry, 1(1), 5-6. Wiley.
    Type: Article DOI: 10.1111/j.1751-7893.2007.00017.x OpenAlex: https://openalex.org/W2100444150
    OpenAlex OpenCitations
  21. Tara A. Lavelle , Milton C. Weinstein , Joseph P. Newhouse , Kerim Munir , Karen A. Kuhlthau , Lisa A. Prosser (2014). Economic Burden of Childhood Autism Spectrum Disorders . Pediatrics, 133(3), e520-e529. American Academy of Pediatrics (AAP).
    Type: Article DOI: 10.1542/peds.2013-0763 OpenAlex: https://openalex.org/W2120181870
    Crossref OpenAlex OpenCitations
  23. Ariane V. S. Buescher , Zuleyha Cidav , Martin Knapp , DAVID S. MANDELL (2014). Costs of Autism Spectrum Disorders in the United Kingdom and the United States . JAMA Pediatrics, 168(8), 721. American Medical Association (AMA).
    Type: Article DOI: 10.1001/jamapediatrics.2014.210 OpenAlex: https://openalex.org/W2110143479
    Crossref OpenAlex OpenCitations
  24. Maarten van ’t Hof , Chanel Tisseur , Ina van Berckelear-Onnes , Annemyn van Nieuwenhuyzen , Amy M Daniels , Mathijs Deen et al. (2021). Age at autism spectrum disorder diagnosis: A systematic review and meta-analysis from 2012 to 2019 . Autism, 25(4), 862-873. SAGE Publications.
    Type: Article DOI: 10.1177/1362361320971107 OpenAlex: https://openalex.org/W3099367322
    Crossref OpenAlex OpenCitations
  25. Diana L. Robins , Karís A. Casagrande , Marianne Barton , Chi-Ming A. Chen , Thyde Dumont-Mathieu , Deborah Fein (2014). Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F) . Pediatrics, 133(1), 37-45. American Academy of Pediatrics (AAP).
    Type: Article DOI: 10.1542/peds.2013-1813 OpenAlex: https://openalex.org/W2137207936
    Crossref OpenAlex OpenCitations
  26. Green (2017). Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years. J Child Psychol Psychiatry, 58(12), 1330. Wiley.
    Type: Other DOI: 10.1111/jcpp.2017.58.issue-12 OpenAlex: https://openalex.org/W4240378598
    Crossref OpenAlex
  27. Michael Ayres , Jeremy R Parr , Jacqui Rodgers , David Mason , Leah Avery , Darren Flynn (2018). A systematic review of quality of life of adults on the autism spectrum . Autism, 22(7), 774-783. SAGE Publications.
    Type: Article DOI: 10.1177/1362361317714988 OpenAlex: https://openalex.org/W2743496150
    Crossref OpenAlex OpenCitations
  28. Mark H. Johnson , Teodora Gliga , Emily JH Jones , Tony Charman (2015). Annual Research Review: Infant development, autism, and ADHD – early pathways to emerging disorders . Journal of Child Psychology and Psychiatry, 56(3), 228-247. Wiley.
    Type: Article DOI: 10.1111/jcpp.12328 OpenAlex: https://openalex.org/W2155698011
    OpenAlex
  30. Jonathan Green , Kathy Leadbitter , John Ainsworth , Sandra Bucci (2022). An integrated early care pathway for autism . The Lancet Child & Adolescent Health, 6(5), 335-344. Elsevier BV.
    Type: Article DOI: 10.1016/s2352-4642(22)00037-2 OpenAlex: https://openalex.org/W4220785946
    Crossref OpenAlex OpenCitations
  31. Lonnie Zwaigenbaum , Margaret Bauman , Wendy L. Stone , Nurit Yirmiya , Annette Estes , Robin L. Hansen et al. (2015). Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research . Pediatrics, 136(Supplement_1), S10-S40. American Academy of Pediatrics (AAP).
    Type: Article DOI: 10.1542/peds.2014-3667c OpenAlex: https://openalex.org/W2199002398
    Crossref OpenAlex OpenCitations
  32. Jessica Brian , Susan E Bryson , Isabel M Smith , Wendy Roberts , Caroline Roncadin , Péter Szatmári et al. (2016). Stability and change in autism spectrum disorder diagnosis from age 3 to middle childhood in a high-risk sibling cohort . Autism, 20(7), 888-892. SAGE Publications.
    Type: Article DOI: 10.1177/1362361315614979 OpenAlex: https://openalex.org/W2288563439
    Crossref OpenAlex OpenCitations
  33. Péter Szatmári , Katarzyna Chawarska , Géraldine Dawson , Stelios Georgiades , Rebecca Landa , Catherine Lord et al. (2016). Prospective Longitudinal Studies of Infant Siblings of Children With Autism: Lessons Learned and Future Directions . Journal of the American Academy of Child & Adolescent Psychiatry, 55(3), 179-187. Elsevier BV.
    Type: Article DOI: 10.1016/j.jaac.2015.12.014 OpenAlex: https://openalex.org/W2227824320
    Crossref OpenAlex OpenCitations
  34. Shephard (2017). Mid-childhood outcomes of infant siblings at familial high-risk of autism spectrum disorder. Autism Research, 10(3), 546. Wiley.
    Type: Other DOI: 10.1002/aur.2017.10.issue-3 OpenAlex: https://openalex.org/W4238620976
    Crossref OpenAlex OpenCitations
  35. Sophie Guy , Gareth Furber , Matthew Leach , Leonie Segal (2016). How many children in Australia are at risk of adult mental illness? Australian & New Zealand Journal of Psychiatry, 50(12), 1146-1160. SAGE Publications.
    Type: Article DOI: 10.1177/0004867416640098 OpenAlex: https://openalex.org/W2311163991
    Crossref OpenAlex OpenCitations
  36. Jonathan Green , Andrew Pickles , Greg Pasco , Rachael Bedford , Ming Wai Wan , Mayada Elsabbagh et al. (2017). Randomised trial of a parent‐mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years . Journal of Child Psychology and Psychiatry, 58(12), 1330-1340. Wiley.
    Type: Article DOI: 10.1111/jcpp.12728 OpenAlex: https://openalex.org/W2605716357
    OpenAlex
  37. Insel (2007). The arrival of preemptive psychiatry. Early Interv Psychiatry, 1(1), 5. Wiley.
    Type: Other DOI: 10.1111/eip.2007.1.issue-1 OpenAlex: https://openalex.org/W4242105191
    Crossref OpenAlex
  38. Wendy E. Hoy (2016). Australian burden of disease study: impact and causes of illness and death in Australia 2011 .
    Type: Article OpenAlex: https://openalex.org/W2783475618
    OpenAlex
  39. Johnson, Mark H. , Gliga, Teodora , Emily JH Jones , Tony Charman (2015). Annual Research Review: Infant development, autism, and ADHD - early pathways to emerging disorders . Journal of Child Psychology and Psychiatry, 56(3), 228. Wiley.
    Type: Other DOI: 10.1111/jcpp.2015.56.issue-3 OpenAlex: https://openalex.org/W4255925853
    Crossref OpenAlex OpenCitations
  40. David Mason , Helen McConachie , Deborah Garland , Alex Petrou , Jacqui Rodgers , Jeremy R Parr (2018). Predictors of quality of life for autistic adults . Autism Research, 11(8), 1138-1147. Wiley.
    Type: Article DOI: 10.1002/aur.1965 OpenAlex: https://openalex.org/W2800039438
    OpenAlex OpenCitations
  41. American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders . American Psychiatric Association Publishing.
    Type: Book DOI: 10.1176/appi.books.9780890425787 OpenAlex: https://openalex.org/W4281687410
    Crossref OpenAlex OpenCitations
  42. Jonathan Green , Kathy Leadbitter , John Ainsworth , Sandra Bucci (n.d.). Research Explorer (The University of Manchester).
    Type: Other OpenAlex: https://openalex.org/W4220998925
    OpenAlex
  43. (n.d.). Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia. 2018. Accessed July 18, 2022. https://www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-causes-of-illness-and-death-in-aus/summary
    Type: Other
    Crossref
  44. (n.d.). Australian Government. National Disability Insurance Agency. Accessed March 8, 2022. https://www.ndis.gov.au/
    Type: Other
    Crossref
  45. (n.d.). US Centers for Disease Control and Prevention. Early brain development. CDC. Accessed 14 July, 2022. https://www.cdc.gov/ncbddd/childdevelopment/early-brain-development.html
    Type: Other
    Crossref
  46. (n.d.). Australian Government Department of Health and Aged Care. Medicare Benefits Schedule. Accessed January 15, 2022. http://www.mbsonline.gov.au
    Type: Other
    Crossref
  47. (n.d.). Victoria State Government Department of Education and Training. Human resources (salaries for Victorian public service employees and salaries for allied health employees). Accessed March 8, 2022. https://www.education.vic.gov.au/hrweb/Documents/Salary-VPS.pdf
    Type: Other
    Crossref
  48. (n.d.). Australian Tax Office. Cents per kilometre method. Accessed March 8, 2002. https://www.ato.gov.au/Business/Income-and-deductions-for-business/Deductions/Deductions-for-motor-vehicle-expenses/Cents-per-kilometre-method/
    Type: Other
    Crossref
  49. (n.d.). National Disability Insurance Agency. Supports and services funded by the NDIS. Accessed March 8, 2022. https://www.ndis.gov.au/providers/becoming-ndis-provider/am-i-ready/supports-and-services-funded-ndis
    Type: Other
    Crossref
  50. (n.d.). National Disability Insurance Agency. Data downloads Australian Government. Accessed March 8, 2022. https://data.ndis.gov.au/data-downloads#budget
    Type: Other
    Crossref
  51. (n.d.). Bloomberg. US-AUD exchange rate. Accessed January 24, 2023. https://www.bloomberg.com/quote/USDAUD:CUR
    Type: Other
    Crossref
  52. (n.d.). Australian Bureau of Statistics. Qualifications and Work 2018-19 (Table 5). Accessed July 18, 2022. https://www.abs.gov.au/statistics/people/education/qualifications-and-work/2018-19
    Type: Other
    Crossref