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Contributing factors to healthcare costs in individuals with autism spectrum disorder: a systematic review

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Behzad Karami Matin, Sarah Byford, Shahin Soltani, Ali Kazemi-Karyani, Ehsan Zereshki, Moslem Soofi, Satar Rezaei, Shiva Tolouei Rakhshan, Parvin Jahangiri

Original languageEnglish
Article number604
JournalBMC Health Services Research
Issue number1
Accepted/In press11 Apr 2022
Published6 May 2022

Bibliographical note

Funding Information: The present study was funded by the Kermanshah University of Medical Sciences through proposal grant number 990902. The funder had no role beyond the funding call in the design of the study, data collection, analysis, data interpretation, or writing the manuscript. Publisher Copyright: © 2022, The Author(s).

King's Authors


Background: Individuals with autism spectrum disorder (ASD) are more likely to use healthcare than their counterparts without disabilities, which imposes high medical costs to families and health systems. This study aimed to investigate healthcare costs and its determinants among individuals with ASD. Methods: In this systematic review, we searched online databases (Web of Science, Medline through PubMed and Scopus) for observational and experimental studies that included data on service use and costs associated with ASD and published between January 2000 and May 2021. Exclusion criteria included non-English language articles, duplicates, abstracts, qualitative studies, gray literature, and non-original papers (e.g., letters to editors, editorials, reviews, etc.). Results: Our searches yielded 4015 articles screened according to PRISMA guidelines. Of 4015 studies identified, 37 articles from 10 countries were eligible for final inclusion. Therapeutic interventions, outpatient visits and medications constituted the largest proportion of direct medical expenditure on individuals with ASD. Included studies suggest lack of health insurance, having associated morbidities, more severe symptoms, younger age groups and lower socioeconomic status (SES) are associated with higher medical expenditure in individuals with ASD. Conclusions: This systematic review identified a range of factors, including lower SES and lack of health insurance, which are associated with higher healthcare costs in people with ASD. Our study supports the formulation of policy options to reduce financial risks in families of individuals with ASD in countries which do not have a tax-based or universal health coverage system.

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