Economic burden of attention-deficit/hyperactivity disorder among children and adolescents in the United States: a societal perspective

Abstract

Objective

To provide a comprehensive evaluation of the economic burden associated with attention-deficit/hyperactivity disorder (ADHD) among children and adolescents from a US societal perspective.

Materials and methods

Direct healthcare costs of children (5–11 years) and adolescents (12–17 years) with ADHD were obtained using claims data from the IBM MarketScan Research Databases (01/01/2017–12/31/2018). Direct non-healthcare and indirect costs were estimated based on literature and government publications. Each cost component was estimated using a prevalence-based approach, with per-patient costs extrapolated to the national level.

Results

The total annual societal excess costs associated with ADHD were estimated at $19.4 billion among children ($6,799 per child) and $13.8 billion among adolescents ($8,349 per adolescent). Education costs contributed to approximately half of the total excess costs in both populations ($11.6 billion [59.9%] in children; $6.7 billion [48.8%] in adolescents). Other major contributors to the overall burden were direct healthcare costs ($5.0 billion [25.9%] in children; $4.0 billion [29.0%] in adolescents) and caregiving costs ($2.7 billion [14.1%] in children; $1.6 billion [11.5%] in adolescents).

Limitations

Cost estimates were calculated based on available literature and/or governmental publications due to the absence of a single data source for all costs associated with ADHD. Thus, the quality of cost estimates is limited by the accuracy of available data as well as the study populations and methodologies used by different studies.

Conclusion

ADHD in children and adolescents is associated with a substantial economic burden that is largely driven by education costs, followed by direct healthcare costs and caregiver costs. Improved intervention strategies and policies may reduce the clinical and economic burden of ADHD in these populations.

Keywords:

• Attention-deficit/hyperactivity disorder
• economic burden
• children
• adolescents
• costs

JEL CLASSIFICATION CODES:

• I15
• I1
• I
• I18

Transparency

Declaration of funding

This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. The study sponsor contributed to and approved the study design, participated in the interpretation of data, and reviewed and approved the manuscript; all authors contributed to the development of the manuscript and maintained control over the final content.

Declaration of financial/other relationships

JS is an employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

LAA received research support from Shire/Takeda, Sunovion, and Otsuka; received consulting fees from Bracket, Shire/Takeda, Sunovion, Otsuka, State University of New York (SUNY), the National Football League (NFL), and Major League Baseball (MLB); and received royalty payments (as inventor) from New York University (NYU) for license of adult attention-deficit/hyperactivity disorder (ADHD) scales and training materials.

AC received research support from Allergan, Takeda/Shire, Emalex, Akili, Ironshore, Arbor, Aevi Genomic Medicine, Neos Therapeutics, Otsuka, Pfizer, Purdue, Rhodes, Sunovion, Tris, KemPharm, Supernus, and the U.S. Food and Drug Administration; was on the advisory board of Takeda/Shire, Akili, Arbor, Cingulate, Ironshore, Neos Therapeutics, Otsuka, Pfizer, Purdue, Adlon, Rhodes, Sunovion, Tris, Supernus, and Corium; received consulting fees from Arbor, Ironshore, Neos Therapeutics, Purdue, Rhodes, Sunovion, Tris, KemPharm, Supernus, Corium, Jazz, Tulex Pharma, and Lumos Pharma; received speaker fees from Takeda/Shire, Arbor, Ironshore, Neos Therapeutics, Pfizer, Tris, and Supernus; and received writing support from Takeda/Shire, Arbor, Ironshore, Neos Therapeutics, Pfizer, Purdue, Rhodes, Sunovion, and Tris.

PGS, MD, FK, MC, AG, and PL are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Otsuka Pharmaceutical Development & Commercialization, Inc., which funded the development and conduct of this study and manuscript.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

JS, LAA, AC, PGS, MD, FK, MC, AG, and PL contributed to the design of the study and interpretation of the data. PGS, MD, FK, MC, AG, and PL contributed to the data collection and data analysis. All authors critically revised the draft manuscript and approved the final content.

Acknowledgements

Medical writing assistance was provided by Flora Chik, an employee of Analysis Group, Inc.

Previous presentation

Part of the material in this manuscript was presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2021 Virtual Meeting from May 17 to 20 as a podium presentation.