Comorbidity prevalence, healthcare utilization, and expenditures of Medicaid enrolled adults with autism spectrum disorders

TLDR

The study retrospectively examined Medicaid data to assess how psychiatric and non‑psychiatric comorbidities affect healthcare utilization and costs among adults with autism spectrum disorders compared to matched controls. Using 2000‑2008 Medicaid Analytic eXtract, 1:3 propensity‑matched ASD and non‑ASD adults were analyzed for outpatient, inpatient, ER, and prescription use and expenditures with chi‑square, multinomial logistic, and gamma‑distributed generalized linear models. Adults with ASD had markedly higher comorbidity rates (81% psychiatric, 22% epilepsy, 22% infections, 21% skin disorders, 18% hearing impairments) and substantially greater utilization and costs—average annual expenditures of US$13,700 versus US$8,560, with each comorbidity adding roughly US$5,000 to total costs.

Abstract

A retrospective data analysis using 2000-2008 three state Medicaid Analytic eXtract was conducted to examine the prevalence and association of comorbidities (psychiatric and non-psychiatric) with healthcare utilization and expenditures of fee-for-service enrolled adults (22-64 years) with and without autism spectrum disorders (International Classification of Diseases, Ninth Revision-clinical modification code: 299.xx). Autism spectrum disorder cases were 1:3 matched to no autism spectrum disorder controls by age, gender, and race using propensity scores. Study outcomes were all-cause healthcare utilization (outpatient office visits, inpatient hospitalizations, emergency room, and prescription drug use) and associated healthcare expenditures. Bivariate analyses (chi-square tests and t-tests), multinomial logistic regressions (healthcare utilization), and generalized linear models with gamma distribution (expenditures) were used. Adults with autism spectrum disorders (n = 1772) had significantly higher rates of psychiatric comorbidity (81%), epilepsy (22%), infections (22%), skin disorders (21%), and hearing impairments (18%). Adults with autism spectrum disorders had higher mean annual outpatient office visits (32ASD vs 8noASD) and prescription drug use claims (51ASD vs 24noASD) as well as higher mean annual outpatient office visits (US$4375ASD vs US$824noASD), emergency room (US$15,929ASD vs US$2598noASD), prescription drug use (US$6067ASD vs US$3144noASD), and total expenditures (US$13,700ASD vs US$8560noASD). The presence of a psychiatric and a non-psychiatric comorbidity among adults with autism spectrum disorders increased the annual total expenditures by US$4952 and US$5084, respectively.