OBJECTIVES: To examine the potential cost-utility of a novel screening device for early diagnosis of autism spectrum disorder (ASD) compared to the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F).

METHODS: We used a decision tree model, under a societal perspective with 5- and 10-year time horizons, to calculate the incremental cost-utility ratio (ICUR) and the net-monetary benefit (NMB) of using innovative pupillometry screening technology in comparing low and high utilization to M-CHAT-R/F (9.4%, and 80%, respectively). We assumed that 90% of the population would have access to the novel device. The willingness to pay threshold was set at $150,000. We explored various levels of diagnostic accuracy of the new device, the range of costs, and health-related quality of life. One-way, two-way, and probabilistic sensitivity analyses were conducted.

RESULTS: In low utilization M-CHAT-R/F settings, the novel screening device was dominant and cost-saving. The expected NMB for the 5- and 10-year time horizons was $15,600 and $15,700, respectively. Diagnostic specificity of the new device was the most influential parameter. The device remained cost-effective in settings with 43% access to M-CHAT-R/F or lower. In high utilization M-CHAT-R/F settings, the device becomes dominated, and the model becomes most sensitive to the negative predictive value of the M-CHAT-R/F tool. The cost of the screening tool had a minimal impact on the model results.

CONCLUSIONS: A novel screening health technology utilizing pupillary measurements for early detection of childhood ASD could provide additional value for children with low access to standard screening. Although the tool was dominated in settings with high utilization of M-CHAT-R/F, further research is necessary to determine whether the novel tool could be beneficial when augmenting M-CHAT-R/F.