Programmatic Costs of Project ImPACT for Children with Autism: A Time-Driven Activity Based Costing Study.

Researchers looked at the costs of running Project ImPACT, a program where specialists teach parents techniques to help their young autistic children communicate better. They found it costs about $14,500 to train each specialist and between $2,600-$9,650 per child depending on how many hours of support families receive each week. The study shows that specialists often work extra unpaid hours, which creates challenges for making these programs available to more families.

This randomized controlled trial examined the programmatic costs of implementing Project ImPACT, an early intervention program where community providers coach caregivers to improve young autistic children's social communication skills. Using Time-Driven Activity-Based Costing methodology, researchers analyzed both implementation and intervention costs from a payer perspective. Implementation costs totaled $43,509 per clinic and $14,503 per clinician, with clinician time representing 60% of personnel costs. Per-child intervention costs ranged from $2,619 (one hour weekly) to $9,650 (four hours weekly).

The study identified that uncompensated clinician time represents a significant cost burden, raising practical and ethical concerns for implementation planning. These findings provide crucial cost data to inform funding decisions and policy development for early autism interventions.

Cost data can inform policy decisions and funding allocation for early autism interventions. The identification of uncompensated clinician time as a major cost driver suggests need for sustainable funding models that adequately compensate providers to ensure program viability and ethical implementation.

The study focused only on first-year costs and took a payer perspective, potentially missing broader societal costs and long-term cost implications. Sample size was not reported, limiting generalizability of findings.

Programmatic cost assessment of clinical interventions can inform future dissemination and implementation efforts. We conducted a randomized trial of Project ImPACT (Improving Parents As Communication Teachers) in which community early intervention (EI) providers coached caregivers in techniques to improve young children's social communication skills. We estimated implementation and intervention costs while demonstrating an application of Time-Driven Activity-Based Costing (TDABC). We defined Project ImPACT implementation and intervention as processes that can be broken down successively into a set of procedures.

We created process maps for both implementation and intervention delivery. We determined resource use and costs, per unit procedure in the first year of the program, from a payer perspective. We estimated total implementation cost per clinician and per site, intervention cost per child, and provided estimates of total hours spent and associated costs for implementation strategies, intervention activities and their detailed procedures. Total implementation cost was $43,509 per clinic and $14,503 per clinician.

Clinician time (60%) and coach time (12%) were the most expensive personnel resources. Implementation coordination and monitoring (47%), ongoing consultation (26%) and clinician training (19%) comprised most of the implementation cost, followed by fidelity assessment (7%), and stakeholder engagement (1%). Per-child intervention costs were $2619 and $9650, respectively, at a dose of one hour per week and four hours per week Project ImPACT. Clinician and clinic leader time accounted for 98% of per child intervention costs.

Highest cost intervention activity was ImPACT delivery to parents (89%) followed by assessment for child's ImPACT eligibility (10%). The findings can be used to inform funding and policy decision-making to enhance early intervention options for young children with autism. Uncompensated time costs of clinicians are large which raises practical and ethical concerns and should be considered in planning of implementation initiatives. In program budgeting, decisionmakers should anticipate resource needs for coordination and monitoring activities.

TDABC may encourage researchers to assess costs more systematically, relying on process mapping and gathering prospective data on resource use and costs concurrently with their collection of other trial data.