PC2068: Time to Autism Diagnosis and Healthcare Utilization and Costs: A Retrospective Commercial Claims Analysis

Background: Prolonged delays between first parental concern and autism spectrum disorder (ASD) diagnosis have been noted in the literature, yet questions remain regarding the diagnostic journey, including the impact of time to diagnosis (TTD) on healthcare resource use (HCRU) and costs in commercial healthcare plans. Our study sought to address these information gaps in the diagnostic pathway.

Methods: We conducted a retrospective, observational, single-cohort analysis of Optum’s administrative commercial claims database from January 1, 2011, to December 31, 2020. Commercially insured children were included if they had ≥2 claims with a diagnosis for ASD (the earliest diagnosis date was designated as the index date), were aged >1.5 to ≤6 years at index date, and were continuously enrolled for up to 48 months during their pre-index baseline period (adjusted based on children’s age at the index date) and for 12 months after the index date. Two cohorts of children (age >1.5 to ≤3 years and >3 to ≤6 years) were stratified into shorter versus longer TTD based on the median TTD calculated from first documented claim for an ASD-related concern to the earliest claim for ASD diagnosis. All-cause and ASD-related HCRU and costs during a 12-month period preceding ASD diagnosis were compared descriptively among children with shorter TTD versus longer TTD.

Results: A total of 8,954 children met selection criteria, with 4,205 aged >1.5 to ≤3 years and 4,749 aged >3 to ≤6 years. Median TTD was 9.5 months for the >1.5 to ≤3 years cohort and 22.1 months for the >3 to ≤6 years cohort. In the year prior to receiving an ASD diagnosis, children who had a longer TTD experienced a greater number of both all-cause and ASD-related health care visits compared with children who had a shorter TTD (Table). For example, the mean and median number of office or home visits were between 1.5x and 2x greater among children who had a longer TTD than among those who had a shorter TTD. The mean all-cause medical cost per child was ~2x higher for those with longer TTD compared with shorter TTD ($5,268 vs. $2,525 per child in the younger age cohort and $5,570 vs. $2,265 per child in the older age cohort). Mean ASD related costs were also higher among both age groups for those with longer versus shorter TTD ($2,355 vs. $859 per child in the younger age cohort and $2,351 vs. $1,144 per child in the older cohort).

Conclusion: In the year prior to diagnosis, children with longer TTD experience more frequent health care visits and greater cost burden in their diagnostic journey compared with children with shorter TTD. Implementing innovative diagnostic tools and pathways that may accelerate TTD could potentially reduce costs and HCRU for commercially-insured children.