Economic analysis of early intervention for autistic children: findings from four case studies in England, Ireland, Italy, and Spain

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Tinelli, M., Roddy, Á., Knapp, M., Arango, C., Méndez, M. A., Cusack, J., Murphy, D., Canitano, R., Oakley, B. F., & Quoidbach, V. (2023). Economic analysis of early intervention for autistic children: findings from four case studies in England, Ireland, Italy, and Spain. European Psychiatry, 66(1), e76-e76. https://doi.org/10.1192/j.eurpsy.2023.2449

Publication date: 1 Jan 2023 Added to AutiHub: 5 Jul 2026 Type: Article Article language: English
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10
Publication authors identified as autistic
1 / 10 (10.0%)
  1. Michela Tinelli
  2. Áine Roddy
  3. Martín Knapp
  4. Celso Arango
  5. María Andreina Méndez
  1. James Cusack *
  2. Declan Murphy
  3. Roberto Canitano
  4. Bethany F. Oakley
  5. Vinciane Quoidbach

Abstract

BACKGROUND: Many autistic children experience difficulties in their communication and language skills development, with consequences for social development into adulthood, often resulting in challenges over the life-course and high economic impacts for individuals, families, and society. The Preschool Autism Communication Trial (PACT) intervention is effective in terms of improved social communication and some secondary outcomes. A previously published within-trial economic analysis found that results at 13 months did not support its cost-effectiveness. We modeled cost-effectiveness over 6 years and across four European countries. METHODS: Using simulation modeling, we built on economic analyses in the original trial, exploring longer-term cost-effectiveness at 6 years (in England). We adapted our model to undertake an economic analysis of PACT in Ireland, Italy, and Spain. Data on resource use were taken from the original trial and a more recent Irish observational study. RESULTS: PACT is cost-saving over time from a societal perspective, even though we confirmed that, at 13 months post-delivery, PACT is more expensive than usual treatment (across all countries) when given to preschool autistic children. After 6 years, we found that PACT has lower costs than usual treatment in terms of unpaid care provided by parents (in all countries). Also, if we consider only out-of-pocket expenses from an Irish study, PACT costs less than usual treatment. DISCUSSION: PACT may be recommended as a cost-saving early intervention for families with an autistic child.

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Cited references
25
Total cited references integrated for this publication.
Cited references with an identified autistic author
3 / 25 (12.0%)
Cited author occurrences identified as autistic
4 / 173 (2.3%)
Among occurrences linked to AutiHub author records: 4 / 75 (5.3%). Distinct cited authors identified as autistic: 4 / 108 (3.7%).
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75 / 173 (43.4%)
Distinct linked cited authors: 32 / 108 (29.6%)
Linked cited-author occurrences not identified as autistic
71 / 75 (94.7%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 71 / 173 (41.0%). Distinct linked cited authors not identified as autistic: 28 / 32 (87.5%).
  1. Helen McConachie , Jeremy R. Parr , Magdalena Glod , Jennifer Hanratty , Nuala Livingstone , Inalegwu P Oono et al. (2015). Systematic review of tools to measure outcomes for young children with autism spectrum disorder . Health Technology Assessment, 19(41), 1-506. National Institute for Health and Care Research.
    Type: Article DOI: 10.3310/hta19410 OpenAlex: https://openalex.org/W1503378164
    Crossref OpenAlex
  2. Áine Roddy , Ciaran O’Neill (2020). Predictors of unmet needs and family debt among children and adolescents with an autism spectrum disorder: Evidence from Ireland . Health Policy, 124(3), 317-325. Elsevier BV.
    Type: Article DOI: 10.1016/j.healthpol.2020.01.005 OpenAlex: https://openalex.org/W3001318518
    Crossref OpenAlex
  3. Renée Romeo , Sarah Byford , Martín Knapp (2005). Annotation: Economic evaluations of child and adolescent mental health interventions: a systematic review . Journal of Child Psychology and Psychiatry, 46(9), 919-930. Wiley.
    Type: Article DOI: 10.1111/j.1469-7610.2005.00407.x OpenAlex: https://openalex.org/W2049609049
    Crossref OpenAlex
  4. Lorna French , Eilis M.M. Kennedy (2018). Annual Research Review: Early intervention for infants and young children with, or at‐risk of, autism spectrum disorder: a systematic review . Journal of Child Psychology and Psychiatry, 59(4), 444-456. Wiley.
    Type: Article DOI: 10.1111/jcpp.12828 OpenAlex: https://openalex.org/W2766794557
    Crossref OpenAlex
  5. Melanie Penner , Meera Rayar , Naazish Bashir , S. Wendy Roberts , Rebecca L. Hancock-Howard , Peter C. Coyte (2015). Cost-Effectiveness Analysis Comparing Pre-diagnosis Autism Spectrum Disorder (ASD)-Targeted Intervention with Ontario’s Autism Intervention Program . Journal of Autism and Developmental Disorders, 45(9), 2833-2847. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-015-2447-0 OpenAlex: https://openalex.org/W2079496903
    Crossref OpenAlex
  6. Áine Roddy , Ciaran O’Neill (2019). The economic costs and its predictors for childhood autism spectrum disorders in Ireland: How is the burden distributed? Autism, 23(5), 1106-1118. SAGE Publications.
    Type: Article DOI: 10.1177/1362361318801586 OpenAlex: https://openalex.org/W2894705201
    Crossref OpenAlex
  7. 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
  8. Ariane V. S. Buescher , Zuleyha Cidav , Martín 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
  9. Joanna Coast (2004). Is economic evaluation in touch with society's health values? BMJ, 329(7476), 1233-1236. BMJ.
    Type: Article DOI: 10.1136/bmj.329.7476.1233 OpenAlex: https://openalex.org/W2150246838
    Crossref OpenAlex
  10. (2019). Failing a generation: delays in waiting times from referral to diagnostic assessment for autism spectrum disorder . Failing a generation: delays in waiting times from referral to diagnostic assessment for autism spectrum disorder.
    Type: Other
    Crossref
  11. the PACT Consortium , Sarah Byford , Maria Cary , Barbara Barrett , Tony Charman , Tony Charman et al. (2015). Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial . BMC Psychiatry, 15(1), 316-316. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1186/s12888-015-0700-x OpenAlex: https://openalex.org/W2199297329
    Crossref OpenAlex
  12. Joaquin Fuentes , Amaia Hervás , Patricia Howlin , (ESCAP ASD Working Party) (2021). ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment . European Child & Adolescent Psychiatry, 30(6), 961-984. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s00787-020-01587-4 OpenAlex: https://openalex.org/W3043444385
    Crossref OpenAlex
  13. Andrew Pickles , Ann Le Couteur , Kathy Leadbitter , Erica Salomone , Rachel Cole-Fletcher , Hannah Tobin et al. (2016). Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial . The Lancet, 388(10059), 2501-2509. Elsevier BV.
    Type: Article DOI: 10.1016/s0140-6736(16)31229-6 OpenAlex: https://openalex.org/W2537346844
    Crossref OpenAlex
  14. Bradley Efron , Robert J. Tibshirani (1993). An Introduction to the Bootstrap . Springer US.
    Type: Book DOI: 10.1007/978-1-4899-4541-9 OpenAlex: https://openalex.org/W3106889297
    Crossref OpenAlex
  15. Laura Bojke , Andrea Manca , Miqdad Asaria , Ronan Mahon , Shijie Ren , Stephen Palmer (2017). How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis . PharmacoEconomics, 35(8), 767-776. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s40273-017-0512-6 OpenAlex: https://openalex.org/W2610482231
    Crossref OpenAlex
  16. (n.d.). [23] Bermingham, D. Almost 45,000 children on “appalling” waiting lists for speech and language help. The Irish Examiner; 2021 [cited 2023 January 6]. https://www.irishexaminer.com/news/arid-40239488.html
    Type: Other
    Crossref
  17. Drummond (2015). Methods for the economic evaluation of health care programmes . Methods for the economic evaluation of health care programmes.
    Type: Other
    Crossref
  18. Kathy Leadbitter , Kathy Leadbitter , Catherine Aldred , Helen McConachie , Ann Le Couteur , Tony Charman et al. (2018). The Autism Family Experience Questionnaire (AFEQ): An Ecologically-Valid, Parent-Nominated Measure of Family Experience, Quality of Life and Prioritised Outcomes for Early Intervention . Journal of Autism and Developmental Disorders, 48(4), 1052-1062. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-017-3350-7 OpenAlex: https://openalex.org/W2767995481
    Crossref OpenAlex
  19. The PACT Consortium , Kathy Leadbitter , Kathy Leadbitter , Catherine Aldred , Barbara Barrett , Tony Charman et al. (2018). The Association Between Child and Family Characteristics and the Mental Health and Wellbeing of Caregivers of Children with Autism in Mid-Childhood . Journal of Autism and Developmental Disorders, 48(4), 1189-1198. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-017-3392-x OpenAlex: https://openalex.org/W2768693229
    Crossref OpenAlex
  20. MacKay (2018). The microsegmentation of the autistic spectrum: economic and research implications for Scotland . The microsegmentation of the autistic spectrum: economic and research implications for Scotland.
    Type: Other
    Crossref
  22. (n.d.). [16] PECUNIA. PECUNIA tools; 2021 [cited 2023 January 6]. https://www.pecunia-project.eu/tools
    Type: Other
    Crossref
  23. Filipa Sampaio , Inna Feldman , Tara A. Lavelle , Norbert Skokauskas (2022). The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review . European Child & Adolescent Psychiatry, 31(11), 1655-1670. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s00787-021-01748-z OpenAlex: https://openalex.org/W3133845812
    Crossref OpenAlex
  25. Catherine Lord , Tony Charman , Alexandra Havdahl , Paul Carbone , Evdokia Anagnostou , Brian Boyd et al. (2022). The Lancet Commission on the future of care and clinical research in autism . The Lancet, 399(10321), 271-334. Elsevier BV.
    Type: Article DOI: 10.1016/s0140-6736(21)01541-5 OpenAlex: https://openalex.org/W4200099564
    Crossref OpenAlex