There are few economic evaluations of strategies for screening,
diagnosing, and treating autism spectrum disorder (ASD). The objective of this
study was to create a discrete event simulation (DES) model of the pathway of
care for children with suspected ASD up to age 6. This model will be used to
perform economic evaluations of screening protocols, diagnostic tests and treat-
ments for ASD.
A DES model was conceived to simulate a Canadian
population of children with suspected ASD. Attributes important for simulation
of entities were identified from the literature and expert opinion. Important
categories of attributes included ASD risk factors, ASD co-morbidities, meas-
ures of development, and measures of severity of ASD. The pathway of care
was created with review of current practice guidelines as well as consultation
with developmental pediatricians. Queuing for screening, diagnosis, and treat-
ment comes from entities accessing limited resources over a period of time.
We will use calibration techniques to set resource and time limits to match
the wait times reported in the literature.
A DES model was built for
children with suspected ASD up to age 6. The DES model addresses population
heterogeneity by including risk factors such as gender, autistic siblings, and older
parents, genetic co-morbidities, and physical and psychological co-morbidities.
The DES model simulates outcomes in terms of ASD severity, IQ, and language
skills. The DES model addresses the issues of wait times that are relevant in
ASD screening, diagnosis, and treatment by having entities queue for limited
The DES modelling approach is well-suited to modelling the pathway of care for ASD patients. Patients with ASD have a wide variety
of disabilities and co-morbidities that can be captured in DES modelling. DES
modelling is also able to address issues of wait times that are prevalent in ASD
screening, diagnosis, and treatment.