Real-world evaluation of prevalence, cohort characteristics, and healthcare utilization and expenditures among adults and children with autism spectrum disorder, attention-deficit hyperactivity disorder, or both.

This study looked at insurance data from nearly 2.4 million people to understand how common autism and ADHD are, and how much healthcare they use. About 4% of adults and 7% of children had autism and/or ADHD diagnoses. People with these conditions used healthcare services much more often than others, especially mental health services, leading to higher medical costs. The study found that having both autism and ADHD together was less common but resulted in the highest healthcare usage and costs.

This large-scale retrospective study analyzed insurance claims from nearly 2.4 million members to examine prevalence, characteristics, and healthcare costs of autism spectrum disorder (ASD), ADHD, and co-occurring ASD-ADHD (AuDHD). Among adults, 4.2% had neurodevelopmental diagnoses (4.0% ADHD, 0.1% ASD, 0.1% AuDHD). Among children, 6.7% had diagnoses (5.0% ADHD, 1.1% ASD, 0.6% AuDHD). All groups showed increased odds of behavioral health comorbidities and significantly higher healthcare utilization rates (615-1025 per thousand monthly for adults; 398-1205 for children) compared to neurotypical peers.

This translated to substantially higher healthcare expenditures, with costs ranging from $140-$292 monthly for adults and $51-$845 for children.

Findings support need for integrated care models addressing behavioral health comorbidities. Healthcare systems should plan for substantially higher service utilization in ASD/ADHD populations. Cost data can inform insurance coverage decisions and resource allocation for neurodevelopmental services.

Cross-sectional design limits causal inferences. Claims-based diagnoses may underestimate true prevalence due to underdiagnosis or coding limitations. Single payor data may not generalize to broader populations. No clinical validation of diagnoses or assessment of intervention effectiveness.

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are among the most common neurodevelopmental disorders. However, significant gaps persist in understanding health and healthcare-related needs of individuals diagnosed with ASD and/or ADHD across the lifespan. Thus, this real-world evaluation sought to characterize the prevalence of ASD, ADHD, and co-existing ASD and ADHD (AuDHD); sociodemographics; frequent comorbidities and co-occurring diagnoses; and healthcare utilization and expenditures among members of a large national payor. This study represents an observational, cross-sectional evaluation of claims from a large national payor.

Retrospective claims analyses of commercial fully insured (C-FI) members from 1/1/2022-12/31/2022 identified diagnoses for ASD and/or ADHD among adults (≥ 18 year) and children (< 18 year). Chi-squared tests, T-tests, and Fisher's exact tests examined between-group differences in sociodemographic, health, and healthcare-related measures among members with neurodevelopmental disorders compared to members without ASD and/or ADHD. Within adults (N = 1,928,106), 4.2% of members (60.2% White, 52.9% female, mean age: 34.1 ± 10.9 year) were diagnosed with neurodevelopmental disorders: ADHD (4.0%, n = 76,515); ASD (0.1%, n = 2,134); or AuDHD (0.1%, n = 1,266) (all P < 0.0001). Within children (N = 464,749), 6.7% of members (47.8% White, 67.5% male, mean age: 11.3 ± 3.8 year) were diagnosed with neurodevelopmental disorders: ADHD (5.0%, n = 23,250); ASD (1.1%, n = 5,098); or AuDHD (0.6%, n = 2,665) (all P < 0.0001).

Increased odds (i.e., ≥ 2) for certain co-occurring diagnoses were consistently observed across all three neurodevelopmental cohorts for adults and children, which were primarily behavioral health (BH)-related. Compared to those without neurodevelopmental disorders, both adults and children with ASD and/or ADHD had higher healthcare utilization rates [adults: 615.2 to 1024.8 per thousand per month (PTPM); children: 398.4 to 1205.3 PTPM; all P < 0.001)]; largely owing to increased use of BH-related services, translating to greater total healthcare expenditures [adults: $140.3 to $292.1 per member per month (PMPM); children: $50.8 to $845.4 PMPM; all P < 0.001)]. Leveraging real-world data of 2,392,855 members from a large national payor, 4.1% of adults and 6.7% of children were diagnosed with ASD and/or ADHD. This population appeared to consistently exhibit specific co-existing diagnoses that frequently co-occur in addition to greater observed healthcare utilization and expenditures.

Trial registration Not applicable.