Skip to main content

Cost-Effectiveness of Universal or High-Risk Screening Compared to Surveillance Monitoring in Autism Spectrum Disorder


The American Academy of Pediatrics recommends universal screening for autism spectrum disorder at 18 and 24 months. This study compared the cost-effectiveness of universal or high-risk screening to surveillance monitoring. Simulation models estimated the costs and outcomes from birth to age 6 years. The incremental cost per child diagnosed by 36 months was $41,651.6 for high-risk screening and $757,116.9 for universal screening from the societal perspective. Universal screening may not be a cost-effective approach to increase earlier treatment initiation, as most children initiated treatment after age 60 months. Eliminating wait times resulted in more children initiated treatment by 48 months, but at a high initial cost that may be offset by future cost-savings related to better outcomes.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


Download references


Tracy Yuen was supported through the Canada Institutes of Health Research Autism Research Training Program, Doctoral Autism Scholars Award, Ontario Graduate Scholarship and RestraComp Hospital for Sick Children Foundation Student Scholarship Program. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The work is based on the doctoral dissertation of Dr. T. Yuen. The authors wish to thank Drs. Jessica Brian, Susan Bryson, Isabel Smith and Lonnie Zwaigenbaum for sharing data from the “Canadian high risk infant cohort” (Infant Sibling study) which informed the observed ASD status for all children and trajectories for high-risk children.

Author information

Authors and Affiliations



All authors (TY, MTC, PS, WJU) contributed to the conceptualization of the model, interpretation of findings, editing of the manuscript andn provided final approval of the paper. TY and WJU were responsible for model building, data analysis and drafting of the manuscript.

Corresponding author

Correspondence to Wendy J. Ungar.

Ethics declarations

Conflict of interest

All authors declare no conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 77 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yuen, T., Carter, M.T., Szatmari, P. et al. Cost-Effectiveness of Universal or High-Risk Screening Compared to Surveillance Monitoring in Autism Spectrum Disorder. J Autism Dev Disord 48, 2968–2979 (2018).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Autism spectrum disorder
  • Cost-effectiveness analysis
  • Health services research
  • Screening