Tuesday, 15 November 2011

The bean counters of autism

Good economic management is an absolute prerequisite for any business. Formulating an accurate business plan, projecting income and expenditure and eventually balancing the books all makes for a healthy venture and the avoidance of future problems. I don't think anyone would disagree with these notions; not even when applied to businesses as large as Government and the various services it offers.

The thing about economics and finance when applied to 'people' services, such as health and social spending, is however that they can tend to resign people to mere statistics. Words like 'cost-benefit ratio' then start to be introduced as per what seems to be happening with childhood heart units here in the UK. I tend to get nervous when I see such words because people, individual statistics, then start getting grouped into larger statistics, which can in some cases lose sight of the individual and their individual needs.

A recent paper published by Barrett and colleagues* adds to what is a growing number of research looking at the economics of autism spectrum conditions. Coincidentally I happened to be reading this blog post asking the question: how expensive is autism? The author's answer, not cheap, but to coin a phrase 'you're worth it'.

Barratt et al considered the various services and wider societal costs of very young children with autism in the UK as part of the PACT consortium study (which unfortunately reported only limited benefit from their parent communication intervention). The figure they arrived at per child with autism ranged from about £53 - £1,116 per month, with an average of £430 or about $680 (US). This figure covered everything from contact with healthcare professionals and other hospital and community services. Interestingly some of the families of the 152 children included in the report received little statutory support.

Other papers have detailed similar economic analyses of autism. This paper for example looked at range of childhood developmental conditions and concluded that aside from severe cognitive impairment, the range of autistic conditions carried one of the more significant economic costs to the public sector. Similar studies have reported similar results (here and here). The 2001 paper by Järbrink & Knapp estimated a cost of £1 billion per year for autism here in the UK, although that was based on an assumed prevalence of 5 per 10,000 people!

There are some difficult questions to ask from this collected number crunching: the numbers of cases, availability of services throughout the lifetime, the financial effects on parents/caregivers, use of intervention and intervening to modify symptom presentation; made all the more difficult by the various 'austerity' measures that are starting to impact on everybody's life in these uncertain times. Unfortunately, questions aplenty, solutions seem to be in short supply.

To finish, I had the pleasure of seeing an updated, reformed version of Arthur 2 Stroke in South Shields a few days back so here is a blast from the past (happy birthday Jane & Geoff).

* Barrett B. et al. Service and wider societal costs of very young children with autism in the UK. JADD. November 2011.