Economic implications of attention-deficit hyperactivity disorder for healthcare systems
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REVIEW ARTICLE
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Economic Implications of Attention-Deficit Hyperactivity Disorder for Healthcare Systems Cynthia L. Leibson and Kirsten Hall Long Department of Health Sciences Research, Mayo Clinic Foundation, Rochester, Minnesota, USA
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1239 1. Method of Literature Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1240 2. Attention-Deficit Hyperactivity Disorder-Related Medical Utilisation . . . . . . . . . . . . . . . . . . . . . . . . . . 1240 2.1 Office Visits and Mental Health Service Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1240 2.2 Emergency Department and Hospital Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1248 2.3 Pharmacological Treatment Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1249 2.3.1 Clinically-Appropriate Pharmacological Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1251 3. Cost Analyses and Cost-Effectiveness Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1252 3.1 Incremental Medical Costs Associated with Attention-Deficit Hyperactivity Disorder . . . . . . 1252 3.2 Cost Effectiveness of Pharmacological Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1254 4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1256 5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1258
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most common chronic conditions of childhood, with adverse consequences that persist through adolescence into adulthood. Thus, the burden of illness associated with ADHD is high for affected individuals, their families, and society at large. This article reviews available information about ADHD-associated utilisation of healthcare resources, direct medical costs, and the costs or cost effectiveness of pharmacological interventions. Published estimates suggest that direct medical costs for youth with ADHD are approximately double those for youth without ADHD. Cross-sectional studies suggest that ADHD-associated incremental costs are highest for mental health services and pharmaceutical costs, and are greatest for youth with comorbid psychiatric conditions and for those being treated with stimulant medication. To guide relevant clinical and health policy, additional research is warranted on the following: source of increased costs observed among
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