The impact of increasing femoral width on anatomic risk factors for patellar instability in paediatric patients: a retrospective MRI case-control study.

Individuals with autism spectrum disorder (ASD) share traits such as deficits in social communication, and repetitive and restricted patterns of behaviour, often from early childhood []. ASD is one of the most prevalent neurodevelopmental conditions, with a median male-to-female ratio of 4.2 []. The prevalence of ASD in Europe varies from 0.48% in France to 3.13% in Iceland [–]. In the north of Spain the prevalence was estimated at 0.59% (95% CI: 0.48–0.73) in a study performed as part of the ‘Autism Spectrum Disorders in the European Union’ (ASDEU) project []. The prevalence, the diagnostic delays [], and the complex management of diverse clinical trajectories of people on the spectrum challenge health systems globally by early, intense and continuous requirements of multidisciplinary interventions addressed by specialized teams []. However, the overall social impact associated with diagnostic uncertainties for ASD, lack of effective treatments, and its economic consequences, rests largely on families. Families of children on the spectrum incur higher health and social costs compared to those of children with other special needs, with parents taking substantial time off work []. Cost of illness (COI) studies highlight the burden associated with a condition in a specific country or setting and can identify the drivers of costs, such as co-occurring conditions, sex, socio-economic and demographic characteristics. This information can be used by authorities to make decisions or set policies. After the first cost estimates for ASD was published by Järbrink and Knapp for the United Kingdom [], other studies have followed suit [–]. A recent review on costs of ASD including approximately 50 publications from several countries identifies six types of costs: healthcare costs; therapeutic costs; special-education costs; costs of accommodation, respite care and out-of-pocket expenses; costs associated with productivity loss for adults on the spectrum; and costs of informal care and lost productivity for family/carers [].