Telehealth-Based Systems for Diagnosis, Management and Treatment of Autism Spectrum Disorders

Background: Over the last two decades, ASD prevalence in the US has been steadily increasing, which has raised significant public health concerns given the shortage of trained specialists in the treatment of ASDs, especially in rural areas. Such prevalence increase has implications for the annual and lifetime per capita societal costs incurred.Currently, the in-person service delivery is the prevailing system for diagnosis, treatment and management of ASDs in the US. Such a system has been unable to address: (1) the increasing gap between service delivery supply and demand, (2) the increasing societal costs for those served, and (3) the unattained societal benefits for those not diagnosed early enough or not offered any early and intensive behavioral intervention treatments, which has been proven to produce substantial benefits over the long run.

Objectives: Evaluate how telehealth for diagnostic evaluation and ASD treatment to date has resolved any of the problems highlighted above. Economically evaluate: (1) whether telehealth service delivery offers greater societal net benefits (the difference between societal economic benefits and societal economic costs) than in-person delivery, (2) the threshold volume of telehealth encounters required for the telehealth delivery to reach a zero societal net benefit, and (3) a systematic evaluation of the cost of the transition process from in-person to telehealth service delivery which will include a schemata for reallocation of provider hours.

Methods: We build a theoretical model to capture telehealth system’s potential in reaching ASD screening market equilibrium under the constraint of full utilization of provider hours and other stylized facts

Results: We estimate the market demand for ASD screening in the US for year 2011. We present an application that summarizes our progress with a case study that focuses on the potential impacts of increased access to care of technology based telehealth in Georgia-South Carolina border. We use social network analysis to envision the future of telehealth service delivery for ASDs.

Conclusions: Comparative full economic evaluations need to be conducted in order to evaluate whether telehealth systems will bring societal cost savings over the long run, and economic benefits from clinical (quality of life adjusted health measures) and socio-economic outcomes exceed economic costs, and are comparable to traditional in-person service outcomes. It is important that economists are involved in the very beginning stages of any individual interventions for proper data collection. In addition, from a system’s perspective, economists need to be involved in assessing and evaluating the advantages and obstacles related to the telehealth and in-person systems becoming complementary and eventually competing systems, in face of the several problems the in-person system has been unable to address.