“We want to identify the most promising, high-impact interventions during the initial few months (up to June 2015), although we will be open to evidence on promising interventions throughout the 18-month period. From June 2015 we will start empirical analysis of the economic case for specific interventions.”
– Martin Knapp & Valentina Iemmi, Personal Social Services Research Unit, London School of Economics and Political Science
The economic case for interventions for people with autism
The primary aim of our work within the National Autism Project is:
- to examine the economic case for a range of interventions in the autism spectrum disorders (ASD) area.
In pursuit of this we will therefore aim:
- to review existing evidence on the effectiveness of interventions in the autism spectrum disorders (ASD) area;
- to review and summarise existing evidence on the cost-effectiveness of interventions;
- to carry out new empirical analyses as both the need and opportunity arise; and
- to consult with experts about research currently underway, to understand the relevance and significance of evidence, to explore the relevance of emerging interventions, and to identify some of the parameters needed for our own analyses.
The term ‘interventions’ includes any action with the potential to improve the lives of people with ASD and/or their families, across any relevant dimension of life, at any stage in the life-course, in any ‘system’ (education, health, social care, housing, employment, community development, etc.) and delivered in any ‘sector’ (public, third sector, private for-profit, or ‘informal’). Risk-reduction or prevention strategies could be included.
By ‘economic case’ we mean one or more of a number of things: What is the impact on public or private expenditure? What is the impact on societal resources more generally (including ‘hidden’ costs such as unpaid support from family or friends)? Does spending on an intervention generate savings in the short- or long-term, and if so to whom and when? If the net effect of an intervention is to increase costs, is it nevertheless likely to be seen as cost-effective because the outcomes achieved are ‘worth it’?
The project started in March 2015 and runs for 18 months. To date we have focused on the evidence review and we are beginning to consult with expert group members. We want to identify the most promising, high-impact interventions during the initial few months (up to June 2015), although we will be open to evidence on promising interventions throughout the 18-month period. From June 2015 we will start empirical analysis of the economic case for specific interventions. Our consultations with individuals from the expert group (and others) will continue throughout the period as needed. We will complete our final report in August 2016, but we will share findings with the Strategy Board as they emerge.
Evidence review: We are currently conducting a rapid literature review and consulting with the expert group to identify evidence on the effectiveness and cost-effectiveness of interventions.
The interventions to be covered are potentially many and various, including: health and social care (e.g. psychosocial therapies, medications, training of clinicians and care staff; including in relation to co-morbidities); education (e.g. positive behaviour support at school); employment (e.g. supported employment); housing (e.g. supported living settings); criminal justice; efforts to change societal attitudes (e.g. awareness campaigns, training of professionals); and also diagnosis, gene profiling and imaging in so far as these are likely to lead to positive impacts on people with ASD or their families. We will describe these Interventions in terms of their components, target population, effectiveness (and the robustness of the evidence), costs, and (potential) availability.
Identification of high-impact interventions: We will then select interventions that show promise in terms of effectiveness against one or more criteria: educational outcomes, better health, improved quality of life, achieving employment, wider social networks or whatever criteria are deemed to be relevant in the circumstances. We aim to include interventions spanning differences in age, ASD type, level of learning disabilities, delivery system and sector. The level (quality) of evidence available will also be described.
Economic modelling: In examining the economic case there are four possibilities, in each case focused on interventions for which there is evidence on effectiveness. (A) If there is already robust economic evidence from the UK then we will provide a summary of the economic case without further analysis. (B) If there is robust economic evidence from outside the UK, or partial UK evidence, then we will use some form of mathematical simulation modelling to examine the economic case in a UK context. (C) If there is no previous economic evidence but we can access data from previous evaluations (e.g. effectiveness trials or observational studies) then we will use simulation modelling or possibly new analyses of the primary dataset to examine economic questions. (D) If there are data in cohort studies, epidemiological surveys or administrative records on measures that have been included in effectiveness studies, we will again explore the use of simulation modelling to examine the economic case for interventions known to have effects on those measures. Parameters for any simulation modelling could be drawn from what we find in the evidence review, from extant datasets (e.g. trials, cohort studies), and from expert opinion where other evidence is not available.
We aim to look at the widest set of economic impacts (and we will separate public, private and societal costs) over different time periods (up to 1 year, from 2-5 years, and over 5 years). However, we can only describe, analyse or comment if suitably robust data are available.
Reporting: For each intervention for which we examine the economic case we expect to prepare a short (probably 2-page) summary that is accessible to a non-technical readership.
Martin Knapp and Valentina Iemmi are leading and conducting much of the work, based in the Personal Social Services Research Unit at the LSE. Anna Rupert (MSc student and speech and language therapist) and Margaret Perkins (Research Officer in PSSRU) are currently assisting on the evidence review.
Plan for the next six months
Over the next six months (April-September 2015) we plan to continue the evidence review and consultations with individuals from the expert group, to start economic analysis for some interventions identified, and to produce the first of the ‘summary economic cases’.