Attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), is associated with increased healthcare costs for people of all ages with the disorder, possibly reflecting use of social care, education resources, treatment and productivity loss by family members due to ADHD-related activities.1-7 Adults with ADHD may also experience a range of financial difficulties and have compulsive spending habits.8,9 ADHD can also be a financial burden to the families of patients.10,11
Healthcare resource use
A major contributory factor to the societal burden of ADHD is the increased healthcare resource use observed in patients with ADHD.
- In the UK, estimated annual healthcare costs associated with the treatment of ADHD in adolescents have been reported as £670 million, with education and National Health Service (NHS) resources accounting for approximately 76% and 24% of spending, respectively. In 2010, this equated to a mean cost per adolescent for NHS, social care and education resources of £5493.1
- Analysis of anonymised claims data from Germany indicated that in 2008, 30,264 patients (mean age 15 years) were diagnosed with ADHD, with a mean total cost of €3888 per patient in that year. This included incremental costs of €2902 per patient in that year, which were mostly due to therapeutic devices and remedies like occupational therapy.2
- In a separate analysis of 9083 newly diagnosed ADHD patients from the same data source, the costs associated with ADHD across different age groups were compared (Table).3
Table: Costs associated with ADHD diagnosis by age groups compared with controls. Reproduced with kind permission from Klora M et al. Health Econ Rev 2015; 5: 40.3
|Children 0–5 years||Children/adolescents 6–17 years||Adults 18 years and older|
|Control group||ADHD||Control group||ADHD||Control group|
|Mean cost per quarter (€)||1898||662||2160||487||3239||936|
An analysis of total national annual ADHD-related costs in Europe — using data from Belgium, Germany, Sweden and the UK and applying findings to the Netherlands (based on Dutch 2011 census data with cost estimates converted to Euros) — indicated that the total national annual ADHD-related costs for the Netherlands ranged from €1041–€1520 million, which included education costs, productivity loss by family members due to ADHD-related activities of the child/adolescent, healthcare costs by family members, healthcare costs for children and adolescents, and social services costs (Figure).4
Figure: National ADHD-related costs (millions) by cost categories in Europe, using the Netherlands as a reference case. Reproduced with kind permission from Le HH et al. Eur Child Adolesc Psychiatry 2014; 23: 587-598.4
Retrospective analysis of healthcare claims in the US found that over a period of 5 years, adults with ADHD (n=150,936) incurred higher annual healthcare costs than control subjects (mean $4306 vs $2418; p<0.001).5 In a separate analysis of the same study populations, it was found that adult patients with ADHD also had significantly more injury claims than adults without ADHD (21.5% vs 15.7%; p<0.0001).6 Furthermore, the direct costs associated with injury claims were higher in adults with ADHD compared with the control group (mean $6482 vs $4381; p<0.0001).6
A US study found that the cost of healthcare resource use — for all inpatient, outpatient, emergency department, behavioural therapy, prescriptions and patient expenditure costs — increased significantly when adults (aged 18–100 years) with ADHD (n=3809) experienced one or more comorbidities.7
- In the single comorbidity group, mean (± standard error) total health expenditure increased by $1822 ± $306.7
- In the multiple comorbidity group, health expenditure increased by $4432 ± $301.7
Table: All-cause healthcare expenditure ($) pre-transitional and post-transitional (single and multiple transitions). Reproduced with kind permission from Kawatkar AA et al. Value Health 2014; 17: 661-668.7
Elevated healthcare resource use may reflect the increased rate of injuries observed in patients with ADHD; in a study of adults enrolled in an employer-sponsored health plan, injury claims were more common in individuals with ADHD than in non-ADHD controls (21.5% vs 15.7%; p<0.0001).6
Adults with ADHD may experience a range of financial difficulties, as indicated by UK results from the European Lifetime Impairment Survey* (sponsored by Shire, now part of Takeda).8
Figure: Financial difficulties associated with adult ADHD: UK results from the European Lifetime Impairment Survey. Reproduced with kind permission from Pitts M et al. Arch Psychiatr Nurs 2015; 29: 56-63.8
Furthermore, results of a series of European and North American focus groups† (sponsored by Shire, now part of Takeda) found that adults with ADHD reported problems with wasteful spending and compulsive shopping, as well as difficulty remembering to pay bills and how much money they had.9
Financial problems affecting parents of children with ADHD
There is some evidence that parents/caregivers of children with ADHD may experience financial difficulties, thus impacting the entire family.10-12
- The European Caregiver Perspective on Pediatric ADHD study (sponsored by Shire, now part of Takeda) reported that 38% of caregivers (n=2872) had been late for work in the past month due to their child’s ADHD, and that 31% of caregivers (n=3688) had altered their employment status due to their child/adolescent’s ADHD.12
- One study in the Netherlands found that the mean annual indirect cost due to absence from work and reduced efficiency at work was more than 3-fold higher for the mothers of children with ADHD (€2243) compared with those who had children with or without other behavioural problems (€408 and €674, respectively).10
A US study found that adults with ADHD had significantly higher absence days (9 vs 7) and turnover (9% vs 5%) compared with adults without ADHD; all p<0.01. Similar results were also found for caregivers of children with ADHD compared with caregivers of children without ADHD: absence days 8 vs 7; and turnover 5% vs 4%, respectively.11
*This survey was an online, cross-sectional, opinion-based survey conducted in adults and designed to assess experiences of ADHD in childhood and adulthood (e.g. impact on work, social life and relationships); and experiences of impairment and general well-being in childhood/adolescence. It was conducted in France, Germany, Italy, the Netherlands, Spain and the UK8
†The average size of a focus group was seven participants (range: 3–9 participants) with a mean age of 36 years. During the focus group, participants were asked questions based on a script/guide which had been designed for the focus group based on a literature review, and feedback/prior experience from expert clinicians from each country. The guide was designed to elicit commentary from the participants in several areas, including how the participants were diagnosed, their childhood experience of ADHD and daily life, social, physiological and physical functioning9
- Telford C, Green C, Logan S, et al. Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivity disorder. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 337-344.
- Braun S, Zeidler J, Linder R, et al. Treatment costs of attention deficit hyperactivity disorder in Germany. Eur J Health Econ 2012; 14: 939-945.
- Klora M, Zeidler J, Linder R, et al. Costs and treatment patterns of incident ADHD patients – a comparative analysis before and after the initial diagnosis. Health Econ Rev 2015; 5: 40.
- Le HH, Hodgkins P, Postma MJ, et al. Economic impact of childhood/adolescent ADHD in a European setting: the Netherlands as a reference case. Eur Child Adolesc Psychiatry 2014; 23: 587-598.
- Hodgkins P, Montejano L, Sasané R, et al. Cost of illness and comorbidities in adults diagnosed with attention-deficit/hyperactivity disorder: a retrospective analysis. Prim Care Companion CNS Disord 2011; 13.
- Hodgkins P, Montejano L, Sasané R, et al. Risk of injury associated with attention-deficit/hyperactivity disorder in adults enrolled in employer-sponsored health plans: a retrospective analysis. Prim Care Companion CNS Disord 2011; 13.
- Kawatkar AA, Knight TK, Moss RA, et al. Impact of mental health comorbidities on health care utilization and expenditure in a large US managed care adult population with ADHD. Value Health 2014; 17: 661-668.
- Pitts M, Mangle L, Asherson P. Impairments, diagnosis and treatments associated with attention-deficit/hyperactivity disorder (ADHD) in UK adults: results from the lifetime impairment survey. Arch Psychiatr Nurs 2015; 29: 56-63.
- Brod M, Pohlman B, Lasser R, et al. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes 2012; 10: 47.
- Hakkaart-van Roijen L, Zwirs BW, Bouwmans C, et al. Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD). Eur Child Adolesc Psychiatry 2007; 16: 316-326.
- Kleinman NL, Durkin M, Melkonian A, et al. Incremental employee health benefit costs, absence days, and turnover among employees with ADHD and among employees with children with ADHD. J Occup Environ Med 2009; 51: 1247-1255.
- Flood E, Gajria K, Sikirica V, et al. The Caregiver Perspective on Paediatric ADHD (CAPPA) survey: understanding sociodemographic and clinical characteristics, treatment use and impact of ADHD in Europe. J Affect Disord 2016; 200: 222-234.