Economic impact of ADHD
Attention-deficit hyperactivity disorder (ADHD) is associated with increased healthcare costs for people of all ages with the disorder, possibly reflecting medication expenses, loss of income from unemployment, increased incidence of accidents and potential substance abuse issues.1-7
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 a German study conducted in 2008, 30,264 patients 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 therapy1
- 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 £5493.7
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).6
National ADHD-related costs (millions) by cost categories in Europe using the Netherlands as a reference case6
- A retrospective analysis of healthcare claims in the US found that over a period of five years, there were 150,936 adults with at least one ADHD-related claim, and overall, adults with ADHD incurred a higher total healthcare expenditure compared with adults without ADHD (p<0.001)3
- Furthermore, 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 with ADHD experienced one (p<0.0001) or more (p<0.0001) comorbidities.8
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).9
Burden to individuals and employers
ADHD carries a burden in terms of absenteeism from the workplace. A study conducted by the World Health Organization in 10 countries across Europe and the Americas reported that workers with ADHD had 22.1 more days of annual absenteeism compared with employees without the disorder (p<0.05).10
Financial difficulties may thus arise for adults with ADHD if they are unable to retain steady employment.
- Research in Norway has indicated that substantially fewer adults with ADHD were in paid employment (22%) compared with population controls (72%)11
- In a US study, adults with self-reported ADHD were less likely to be employed (either full- or part-time), more likely to be looking for work and reported changing jobs more frequently in the previous 10 years, compared with controls (Table).12
Employment status among US adults aged 18–64 years with self-reported ADHD12
|ADHD (n=500)||Controls (n=501)|
|Looking for work||14%***||5%|
|Mean number of jobs held over previous 10 years||5.4***||3.4|
Furthermore, a series of European and North American focus groups found that 49% of adults with ADHD (n=53) experienced problems with finances and spending.13
In addition, there is some evidence that parents/caregivers of children with ADHD may experience financial difficulties, thus impacting the entire family.
- 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 three-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)5
- 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 to caregivers of children with ADHD compared with caregivers of children without ADHD: absence days 8 vs 7; and turnover 5% vs 4%, respectively.14
- Braun S, Zeidler J, Linder R, et al. Treatment costs of attention deficit hyperactivity disorder in Germany. Eur J Health Econom 2013; 14: 939-945.
- Biederman J, Faraone SV. The effects of attention-deficit/hyperactivity disorder on employment and household income. Med Gen Med 2006; 8: 12.
- Hodgkins P, Montejano L, Sasane 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.
- de Ridder A, de Graeve D. Healthcare use, social burden and costs of children with and without ADHD in Flanders, Belgium. Clin Drug Investig 2006; 26: 75-90.
- 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.
- 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.
- 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.
- 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.
- Hodgkins P, Montejano L, Sasane 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.
- de Graaf R, Kessler RC, Fayyad J, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med 2008; 65: 835-842.
- Gjervan B, Torgersen T, Nordahl HM, et al. Functional impairment and occupational outcome in adults with ADHD. J Atten Disord 2012; 16: 544-552.
- Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
- 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.
- 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.
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DSM-5TM and ICD-10 medical classification systems are used to accurately diagnose patients with ADHD