1. Economic Costs of Autism Martin Knapp London School of Economics & King’s College London (IoP) Based on research conducted with Renee Romeo & Jennifer Beecham

2. Our over-riding concern is how to meet personal & family needs … So why is economics relevant? Scarcity  never enough resources to meet all of society’s needs or wants. So … economists are asked to look carefully at: costs cost-effectiveness how to improve resource allocation Why?  Today’s focus

3. 1. Prevalence 2. Level of functioning 3. Place of residence 4. Service use patterns 5. Family expenses 6. Lost employment 7. Costs per person 8. UK-wide costs 9. Lifetime costs Methods

4. Many different prevalence estimates, growing over time … Could be due to: Better recognition of needs? More accurate diagnosis? Or underlying growth in prevalence? Most recent study is by Gillian Baird et al (Lancet 2006) in SE England of children aged 9-10  We have assumed prevalence of 1% of total UK population have ASD Prevalence

5. Estimated numbers of people with ASD in the UK, 2005 Age groupHigh functioning Low functioning 0-3 yrs12431520 4-11 yrs25,67531,381 12-17 yrs21,23925,958 18+ yrs194,737238,013 All242,894296,872

6. The autism spectrum contains a number of different conditions or needs … … with different behavioural characteristics, … and different implications for support from families, formal services etc … and hence (probably) different costs We were hampered by lack of data and we have simply distinguished: low-functioning ASD (IQ<70) high-functioning ASD (IQ>70) From Gillian Baird’s study we assumed:  55% of people with ASD are low-functioning  45% are high-functioning Functioning

7. Where do people with ASD live? Again – very difficult to find any national or even local data … so estimates made from various sources (NAS, Emerson report on people with ID, Bebbington & Beecham on Children in Need …) Children: All high-functioning children live in private households 2% of low-functioning children are in residential care or foster placements Residence

8. Estimated places of residence for adults with ASD (%) High functioning Low functioning Private households 79%35% Supported housing 5%7% Residential care 16%52% Hospital-6% All100%

9. What services and supports do people with ASD receive? We got data from: Our own previous studies of people with intellectual disability – looking at those with ASD – mostly from England Jeni Beecham’s work on Children in Need data for England The ONS survey of mental health problems (children) 2004, Great Britain A Scottish study by Anna Cooper et al A Swedish study of HF ASD people We re-grouped and inflated these data to fit residence categories and cover UK Services

10. In addition we looked at family costs: Out-of-pocket payments for services or treatments Time spent on informal care … but could not find any data Lost income because of disrupted employment (= lost productivity) And we also looked at: Lost productivity for people with ASD who were not in employment And we estimated social security benefits received – but these might ‘double-count’ some other costs Other costs

11. Children with HF ASD: average annual costs (£)

12. Adults with LF ASD: average annual costs (£)

13. Children – annual cost in the UK Low-functioning ASD = £1,727 mill. High-functioning ASD = £991 mill. Adults – annual cost in the UK Low-functioning ASD = £16,907 mill. High-functioning ASD = £8,573 mill. Costs of ASD – UK - 2005/06

14. Aggregate cost – for children and adults - for high-functioning and low functioning autism: £28 billion Overall UK cost of ASD

15. Someone with low-functioning ASD = £4.7 million Someone with high-functioning ASD = £2.9 million Lifetime cost of ASD

16. 1.Huge overall economic impact 2.Costs are widely spread across different budgets and parts of government – need coordination 3.High costs fall to families – Is this fair? Is it sustainable? 4.High costs associated with lost employment: Can we do better to support people into jobs? 5.High costs of supporting adults with ASD  can we reduce them by offering better and earlier intervention? And so …?

17. Contact details: m.knapp@LSE.ac.uk m.knapp@LSE.ac.uk