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Cost of assessing a child for possible autism spectrum disorder? An observational study of current practice in child development centres in the UK
  1. Mark Galliver1,
  2. Emma Gowling1,
  3. William Farr1,2,
  4. Aaron Gain3,
  5. Ian Male1,4
  1. 1 Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
  2. 2 Department of Research and Development, Sussex Community NHS Trust, Brighton, UK
  3. 3 West Sussex Health and Social Commissioning, Chichester, UK
  4. 4 Department of Community Child Health, Sussex Community NHS Foundation Trust, Haywards Heath, UK
  1. Correspondence to Dr Ian Male; ian.male{at}tiscali.co.uk

Abstract

Objective UK guidelines recommend that diagnosis of autism in children requires assessment by a multidisciplinary team. With growing numbers of referrals for assessment, diagnostic services have been under increasing pressure to meet the level of need. This study aimed to explore the number of hours of professional time required to complete such an assessment based on current practice in secondary care child development centres across the UK, and from this we calculate the cost of assessment.

Design An online questionnaire, using SurveyMonkey.com, was sent to 20 child development centres asking them to retrospectively record team members involved at each stage of assessment and time taken, including report writing and administration for a typical assessment. Costs were estimated based on the hourly rate for each team member, including salary, on-costs and trust overheads.

Results 12 questionnaires (60%) were returned. 10 centres adopted a two-stage approach to assessment with an initial ‘screening’ clinic determining whether the child needed to proceed to full multidisciplinary assessment. Median professional time involved was 13 hours (IQR 9.6–15.5 hours). This resulted in a median cost of £809 ($1213, based on conversion rate £1 equal to US$1.5 (November 2015)), (IQR £684–£925) ($1026–$1388)).

Implications This study confirms that multidisciplinary diagnostic assessment of a child with possible autism requires significant professional time, with staff costs of approximately £800 ($1200) per child. This does not include costs of intervention, parent psychological education, investigation and assessment and management of comorbidities. If growing waiting times for diagnostic assessment are to be avoided, funding for diagnostic services needs to reflect the human resources required and the resulting costs of that assessment.

  • autism
  • costing
  • neurodevelopment
  • paediatric staffing

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors All five authors contributed to the writing of the paper. IM and WF conceived and lead the study and supervised MG and EG in completing their Independent Research Projects conducted as part of their medical degrees at Brighton and Sussex Medical School and led the writing up of the final paper. MG collected and analysed the initial data and presented this to the peer-reviewed BACCH national conference winning the presentation prize (2013), under supervision as above. This paper was based on his resulting dissertation, along with contributions from EG’s dissertation that continued the research, as well as winning the Brighton and Sussex Medical School silver award for medical student research projects. MG also contributed his prior experience, having worked as an accountant before studying medicine. AG brought the perspective of a commissioner, including a review of the relevant commissioning and costings literature, in writing the paper. IM also brought his knowledge from almost 20 years of clinical experience in diagnostic assessment of children with possible autistic spectrum disorder and his involvement in the BACCH Informatics Group to the study and paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The original data for individual centres are held by Dr Ian Male and Dr William Farr. Analysis of all data is contained in this paper. No additional data are available.

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