Autism is associated with complex and diverse needs that vary from individual to individual. Those affected, and their families, often require specialist care and support. These involve educational and clinical skills which are demanding to implement effectively, and costly, in terms of time and money, to deliver. Early screening and intervention approaches, which can improve outcomes, sometimes dramatically, require government prioritisation of investment. A coordinated, evidence-based approach to screening and support is critical for ensuring that individuals with autism thrive. Autism is, of course, a global phenomenon. Whilst its meaning and significance will inevitably vary from one culture to the next, epidemiological studies report similar presentations and rates across all nations and ethnic/racial groupings. Indeed, the provision of effective services to support people with autism is recognised as a universal human right and a global health priority (Divan et al., this issue). However, although the care needs of people with autism are largely similar across the nations of the world, they will inevitably involve a disproportionate call on the finances of less wealthy nations – and a nation’s ability to meet the needs of people with autism is inevitably constrained by their financial circumstances. Countries with limited resources have very difficult choices to make between competing calls for investment that impact their ability to prioritise services for people with autism. Here we explore the implications of these constraints and the best way to address them in the light of the review by Divan et al.