ADHD Takes Heavy Economic Toll

Megan Brooks

November 12, 2012

Attention-deficit/hyperactivity disorder (ADHD) has a "substantial" economic impact in the United States, with overall incremental costs ranging from $143 to $266 billion annually, a new study suggests.

Surprisingly, researchers note, the cost burden is 3-fold higher in adults ($105 to $194 billion) than in children and adolescents ($38 to $73 billion).

For adults, the largest cost drivers are workplace productivity and income losses ($87 to $138 billion). For children, the largest cost categories are healthcare costs ($21 to $44 billion) and education costs ($15 to $25 billion).

"ADHD is often perceived as a childhood disease, but this analysis demonstrates that at a national level, the economic impact of ADHD on adults may be larger than that on children," study investigator Peter Neumann, ScD, director, Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, said in a statement.

"ADHD is not only a pediatric disorder," coinvestigator Paul Hodgkins, PhD, senior director, Global Health Economics and Outcomes Research at Shire Specialty Pharmaceuticals, added in an email to Medscape Medical News. "Adult ADHD has serious implications — for the adult patient, his family, and the workplace. More emphasis has to be given to identifying and appropriately treating adult ADHD," he said.

"Striking" Finding

The study, which was funded by Shire, is published in the October issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"Particularly striking is the finding that the lion's share of overall costs (almost 75%) is attributable to adults with ADHD and adult family members of individuals with ADHD rather than to children," A. Reese Abright, MD, director, Child and Adolescent Psychiatry, Mount Sinai School of Medicine–Elmhurst Hospital Center, in New York City, writes in an editorial in the journal.

The findings stem from a review of the literature from 1990 to 2011 on the economic impact of ADHD. The study team identified and included in their analysis 19 US-based studies that reported annual incremental (excess) costs per ADHD individual above non-ADHD control participants or from which these costs could be calculated.

They calculated per-person incremental costs adjusted to 2010 US dollars and converted to annual national incremental costs of ADHD based on 2010 US census population estimates, ADHD prevalence rates, number of household members, and employment rates by age group.

Dr. Abright says that this "timely article" is notable for its findings and the clarity with which the authors describe their methodology and how they calculated ADHD-related costs in children and adults, as well as spillover costs borne by the family members of individuals with ADHD. These spillover costs range from $33 to $43 billion.

The analysis, she notes, "consolidates and extends" previous findings and "adds to the growing literature on the burden associated with psychiatric disorders that begin in childhood."

Impact of Treatment Unclear

Estimates of cost naturally lead to questions about the effectiveness of prevention and treatments in lowering costs. The current analysis did not evaluate the impact of treatment interventions on excess costs due to the lack of available data.

On this front, Dr. Abright noted that the incorporation of assessments of the comparative cost-effectiveness of treatment arms in large multisite studies such as the National Institute of Mental Health's Multimodal Study of Treatment of Children with ADHD (MTA) and the Treatment of Adolescents with Depression Study (TADS) has been a "promising development."

Dr. Neumann and colleagues note that the "substantial and multifaceted societal costs of ADHD" call for the development of public policies to address the burden of the condition.

This analysis was funded by Shire Development LLC. Several of the authors have financial relationships with the company. The original article has a complete list of the authors' disclosures. Dr. Abright has disclosed no relevant financial relationships.

J Am Acad Child Adolesc Psychiatry. 2012;51:987-988,990-1002. Abstract