Direct Health Care Costs for Children with Pervasive Developmental Disorders: 1996–2002

  • Scott C. Flanders
  • Luella Engelhart
  • Gahan J. Pandina
  • James T. McCracken
Original Paper


We compared direct costs of treatment of Pervasive Developmental Disorder (PDD), asthma, and diabetes in children aged 3–17 years. A retrospective, claims-based study was conducted using the California Medicaid (Medi-Cal) database (1996–2002). Seven hundred and thirty-one children with PDD were identified and matched for sex with an equal number of randomly selected children with asthma and diabetes. Mean total health care costs for PDD were two- to threefold higher than for asthma and diabetes post-diagnosis ($4,815 vs. $1,469 vs. $2,404, respectively, P < 0.0001). Children with PDD incur significantly greater health care costs when compared with children with other chronic pediatric diseases.


Autism Cost Health care Cost of illness 



Anna Georgieva, MD, PhD and Remon van den Broek, PhD provided editorial support for this manuscript. Preparation of this article was supported by funding from Janssen Medical Affairs, LLC. Recognition to Jeffrey S. Markowitz of Health Data Analytics for his statistical consultation.


  1. American Psychological Association (1994). Diagnostic and statistical manual of mental disorders:DSM-IV (4th ed.). Washington, DC: Author.Google Scholar
  2. Barbaresi, W. J., Katusic, S. K., & Colligan, R. C. (2005). The incidence of autism in Olmsted County, Minnesota, 1976–1997: Results from a population-based study. Archives of Pediatrics and Adolescent Medicine, 159, 37–44.PubMedCrossRefGoogle Scholar
  3. Birenbaum, A., Guyot, D., & Cohen, H. J. (1990). Health care financing for severe developmental disabilities. Monographs of the American Association on Mental Retardation, 14, 1–150.PubMedGoogle Scholar
  4. Burd, L., Klug, M. G., Coumbe, M. J., & Kerbeshian, J. (2003). Children and adolescents with attention deficit-hyperactivity disorder: 1. Prevalence and cost of care. Journal of Child Neurology, 18, 555–561.Google Scholar
  5. California Health and Human Services Agency. Autistic Spectrum Disorders. (2003). Changes in the California caseload, an update: 1999 through 2002. Retrieved November 17, 2005, from Scholar
  6. Charman, T., & Baird, G. (2002). Practitioner review: Diagnosis of autism spectrum disorders in 2- and 3-year old children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 43, 289–305.PubMedGoogle Scholar
  7. Croen, L. A., Grether, J. K., Hoogstrate, J., & Selvin, S. (2002). The changing prevalence of autism in California. Journal of Autism and Developmental Disorders, 32, 207–215.PubMedCrossRefGoogle Scholar
  8. Curran, A. L., Sharples, P. M., White, C., & Knapp, M. (2001) Time costs of caring for children with severe disabilities compared with caring for children without disabilities. Developmental Medicine and Child Neurology, 43, 529–533.PubMedCrossRefGoogle Scholar
  9. Druss, B. G., Marcus, S. C., Olfson, M., Tanielian, T., Elinson, L., & Pincus, H. A. (2001). Comparing the national economic burden of five chronic conditions. Health Affairs (Millwood), 20, 233–241.CrossRefGoogle Scholar
  10. Flanders, S. C., Engelhart, L., Whitworth, J., Hussein, M. A., Vanderpoel, D. R., & Sandman, T. (2006). The economic burden of pervasive developmental disorders in a privately insured population. Managed Care Interface, 19, 39–45.PubMedGoogle Scholar
  11. Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: an update. Journal of Autism and Developmental Disorders, 33, 365–382.PubMedCrossRefGoogle Scholar
  12. Grosse, S. D., & Shimabukuro, T. T. (2005) Direct medical costs of autism in a privately insured population. Poster presented at the AcademyHealth Annual Research Meeting, Boston, MA, 26–28, June 2005, Retrieved from Accessed 17 November 2005.Google Scholar
  13. Guevara, J., Lozano, P., Wickizer, T., Mell, L., & Gephart, H. (2001). Utilization and cost of health care services for children with attention-deficit/hyperactivity disorder. Pediatrics, 108, 71–78.PubMedCrossRefGoogle Scholar
  14. Icks, A., Rosenbauer, J., Haastert, B., Rathmann, W., Grabert, M., Gandjour, A., Giani, G., & Holl, R. W. (2004). Direct costs of pediatric diabetes care in Germany and their predictors. Experimental and Clinical Endocrinology and Diabetes, 112, 302–309.PubMedCrossRefGoogle Scholar
  15. Järbrink, K., Fombonne, E., & Knapp, M. (2003). Measuring the parental, service and cost impacts of children with autistic spectrum disorder: a pilot study. Journal of Autism and Developmental Disorders, 33, 395–402.PubMedCrossRefGoogle Scholar
  16. Järbrink, K., & Knapp, M. (2001). The economic impact of autism in Britain. Autism: The International Journal of Research and Practice, 5, 7–22.Google Scholar
  17. Kuhlthau, K., Perrin, J. M., Ettner, S. L., McLaughlin, T. J., & Gortmaker, S. L. (1998). High-expenditure children with supplemental security income. Pediatrics, 102, 610–615.PubMedCrossRefGoogle Scholar
  18. Leibson, C. L., Katusic, S. K., Barbaresi, W. J., Ransom, J., & O’Brien, P. C. (2001). Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder. JAMA: The Journal of the American Medical Association, 285, 60–66.CrossRefGoogle Scholar
  19. Lozano, P., Fishman, P., VonKorff, M., & Hecht, J. (1997). Health care utilization and cost among children with asthma who were enrolled in a health maintenance organization. Pediatrics, 99, 757–764.PubMedCrossRefGoogle Scholar
  20. Newacheck, P. W., Inkelas, M., & Kim, S. E. (2004). Health services use and health care expenditures for children with disabilities. Pediatrics, 114, 79–85.PubMedCrossRefGoogle Scholar
  21. Newacheck, P. W., & Kim, S. E. (2005) A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 159, 10–17.PubMedCrossRefGoogle Scholar
  22. Newschaffer, C. J., & Curran, L. K. (2003) Autism: An emerging public health problem. Public Health Reports, 118, 393–399.PubMedGoogle Scholar
  23. Ungar W. J., Coyte P. C., Gaebel K. A., Goldsmith C. H., Levine M. A. H., Willison D. J., & Poston J. W. (2001). Prospective study of the patient-level cost of asthma care in children. Pediatric Pulmonology, 32, 101–108.PubMedCrossRefGoogle Scholar
  24. Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doernberg, N., Boyle, C., & Murphy, C. (2003) Prevalence of autism in a US metropolitan area. JAMA: The Journal of the American Medical Association, 289, 49–55.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Scott C. Flanders
    • 1
  • Luella Engelhart
    • 2
  • Gahan J. Pandina
    • 3
  • James T. McCracken
    • 4
  1. 1.Regional Outcomes ResearchOrtho McNeil-Janssen Scientific Affairs, LLCGrayslakeUSA
  2. 2.Health Economics & ReimbursementCordis CorporationWarrenUSA
  3. 3.CNS Clinical Development at Medical Affairs DivisionJanssen Pharmaceutica Products, LPTitusvilleUSA
  4. 4.Department of Child PsychiatryUCLA Neuropsychiatric InstituteLos AngelesUSA

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