Evidence-based use of scalable biomarkers to increase diagnostic efficiency and decrease the lifetime costs of autism.

Challenges associated with the current screening and diagnostic process for autism spectrum disorder (ASD) in the US cause a significant delay in the initiation of evidence‐based interventions at an early age when treatments are most effective. The present study shows how implementing a second‐order diagnostic measure to high risk cases initially flagged positive from screening tools can further inform clinical judgment and substantially improve early identification. We use two example measures for the purposes of this demonstration; a saliva test and eye‐tracking technology, both scalable and easy‐to‐implement biomarkers recently introduced in ASD research. Results of the current cost‐savings analysis indicate that lifetime societal cost savings in special education, medical and residential care are estimated to be nearly $580,000 per ASD child, with annual cost savings in education exceeding $13.3 billion, and annual cost savings in medical and residential care exceeding $23.8 billion (of these, nearly $11.2 billion are attributable to Medicaid). These savings total more than $37 billion/year in societal savings in the US. Initiating appropriate interventions faster and reducing the number of unnecessary diagnostic evaluations can decrease the lifetime costs of ASD to society. We demonstrate the value of implementing a scalable highly accurate diagnostic in terms of cost savings to the US. This paper demonstrates how biomarkers with high accuracy for detecting autism spectrum disorder (ASD) could be used to increase the efficiency of early diagnosis. Results also show that, if more children with ASD are identified early and referred for early intervention services, the system would realize substantial costs savings across the lifespan.

美国自闭症谱系障碍（ASD）当前的筛查和诊断过程存在诸多问题，导致在儿童早期这个治疗最有效的阶段，基于实证的干预措施无法及时开展。本研究表明，对最初通过筛查工具被标记为阳性的高风险病例实施二级诊断措施，如何能够进一步为临床判断提供依据，并显著提高早期识别能力。出于本次论证的目的，我们使用了两个示例指标：唾液检测和眼动追踪技术，这两种生物标记物在自闭症研究中近期被引入，具有可扩展性且易于实施。当前成本节约分析的结果表明，在特殊教育、医疗和住宿护理方面，每个自闭症儿童一生可为社会节省的成本估计接近58万美元，教育方面每年节省的成本超过133亿美元，医疗和住宿护理方面每年节省的成本超过238亿美元（其中近112亿美元可归因于医疗补助计划）。这些节省总计每年为美国社会节省超过370亿美元。更快地启动适当的干预措施并减少不必要的诊断评估次数，可以降低自闭症给社会带来的终身成本。我们论证了实施一种可扩展的高精度诊断方法在为美国节省成本方面的价值。 本文论证了用于检测自闭症谱系障碍且具有高精度的生物标记物如何能够提高早期诊断的效率。研究结果还表明，如果更多的自闭症儿童能够被早期识别并被转介接受早期干预服务，整个系统在其生命周期内将实现大量的成本节约。