Types of Services and Costs of Programs for Preschoolers with Autism Spectrum Disorder Across Sectors: A Comparison of Two Canadian Provinces

  • Kate Tsiplova
  • Wendy J. UngarEmail author
  • Helen E. Flanagan
  • Jeffrey den Otter
  • Charlotte Waddell
  • Patricia Murray
  • Barbara D’Entremont
  • Natalie Léger
  • Nancy Garon
  • Susan Bryson
  • Isabel M. Smith


This study measured resource utilization and costs for pre-school autism spectrum disorder (ASD)-related services in community-based sectors from multiple payer perspectives in two Canadian provinces, Nova Scotia (NS) and New Brunswick (NB), during the 12 months prior to and following the start of early intensive behavioural intervention (EIBI). The results indicate significant differences between NB and NS in utilization of services and costs to families, public sector and society. Differences can be attributed to variation in EIBI delivery models and may also be influenced by differences in diagnostic assessment practices. The study results provide resource utilization rates and costs which could be used in future economic evaluations and to inform policy making to improve outcomes for children with ASD.


Autism spectrum disorder Cost Service use Preschool-aged children 



This study was funded by a Canadian Institutes of Health Research ‘Partnerships for Health Systems Improvement’ operating Grant (#PHE 122189), by partner funding from the Nova Scotia Health Research Foundation and New Brunswick Health Research Foundation, and by the 2017 SickKids Lunenfeld Summer Studentship program. PATI study’s Principal Investigator Smith was supported by the Joan and Jack Craig Chair in Autism Research. We thank Noreen Millar, Jennifer Fox, Susan Harvey, and Marie-Lyn Fackenthall, research coordinators, for their help with collecting and using the PATI study data. We acknowledge the work of Salar Sadri on resource pricing and costing. We also appreciate the help of PATI team members, service providers and Nova Scotia EIBI managers who provided cost data. We would especially like to thank all of the participating families.

Author Contributions

KT participated in the interpretation of the data, performed statistical analysis and drafted the manuscript; WU conceived the study, contributed to its design and coordination and to the interpretation and statistical analysis of the data and drafted the manuscript; BD, HF, NG, JD, CW and PM participated in the design and coordination of the study and the interpretation of the data; NL contributed to the design and coordination of the study; SB conceived of the study and participated in its design; IS conceived of the study, participated in its design and coordination and contributed to the interpretation of the data. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10803_2019_3993_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 48 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kate Tsiplova
    • 1
  • Wendy J. Ungar
    • 1
    • 2
    • 10
    Email author
  • Helen E. Flanagan
    • 3
  • Jeffrey den Otter
    • 4
  • Charlotte Waddell
    • 5
  • Patricia Murray
    • 6
  • Barbara D’Entremont
    • 7
  • Natalie Léger
    • 4
  • Nancy Garon
    • 8
  • Susan Bryson
    • 3
    • 9
  • Isabel M. Smith
    • 3
    • 9
  1. 1.Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoCanada
  2. 2.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  3. 3.Autism Research CentreIWK Health CentreHalifaxCanada
  4. 4.Department of Education and Early Childhood DevelopmentGovernment of New BrunswickFrederictonCanada
  5. 5.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  6. 6.Department of Health and WellnessGovernment of Nova ScotiaHalifaxCanada
  7. 7.Department of PsychologyUniversity of New BrunswickFrederictonCanada
  8. 8.Department of PsychologyMount Allison UniversitySackvilleCanada
  9. 9.Department of PediatricsDalhousie UniversityHalifaxCanada
  10. 10.Program of Child Health Evaluative SciencesThe Hospital for Sick Children Peter Gilgan Centre for Research and LearningTorontoCanada

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