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

Figures & data

Table 1. Summary of clinical findings and costs for each component of the total economic burden of ADHD in children and adolescents.

Method of estimation		Excess due to ADHD based on data^a	Number of individuals	Unit cost	Total excess costs due to ADHD (% of total societal costs)	Total excess costs per individual	References
Total societal costs
Sum of all mutually exclusive cost components	Children	–	2,856,780	–	$19,423,935,825 (100%)	$6,799
	Adolescents	–	1,655,303	–	$13,819,588,815 (100%)	$8,349
Direct healthcare					$9,035,973,781	$2,003
Bottom-up: Average excess costs of a patient with ADHD compared to a matched patient without ADHD, applied to the population of individuals with ADHD by insurance type and adjusted for the proportion of patients who seek treatment	Children	$2,801	1,793,577	–	$5,024,322,947 (25.9%)	$1,759	MarketScan^4^,^41
	Adolescents	$3,718	1,079,082	–	$4,011,650,834 (29.0%)	$2,424	MarketScan^4^,^41
Direct non-healthcare					$19,048,622,845	$4,222
Education
Bottom-up: Estimated average cost of education^b for an individual with ADHD compared to an individual without ADHD applied to the population of individuals with ADHD	Children	$4,076	2,747,064	–	$11,643,338,245 (59.9%)	$4,076	^43^,^44^,^45^,^89^,^90
	Adolescents	$4,076	1,594,532	–	$6,746,495,259 (48.8%)	$4,076	^43^,^44^,^45^,^89^,^90
Research and training
Top-down: Existing data on funding allocated to ADHD by the National Institute of Health and proportionally adjusted for the proportion of the individuals with ADHD in the US who were children/adolescents	Children	$12,515,637	–	–	$12,515,637 (0.1%)	$4	^42
	Adolescents	$7,251,931	–	–	$7,251,931 (0.1%)	$4	^42
Substance use disorder
Top-down: Existing data on costs of alcohol and drug use to derive costs per person with substance use disorder in the US applied to the estimated number of individuals with ADHD with substance use disorder	Adolescents	–	–	–	$443,464,076 (3.2%)	$268
	Alcohol use disorder	5.4%	89,021	$723	$64,386,280 (0.5%)	–	^46^,^47^,^48
	Drug use disorder	8.8%	145,667	$2,602	$379,077,796 (2.7%)	–	^22^,^48^,^49
Road traffic accidents
Bottom-up: Estimated costs per road traffic accident multiplied by the total number of road traffic accidents, proportionally adjusted by the rate ratio of road traffic accidents among individuals with ADHD compared to those without ADHD	Adolescents	1.27 times the accident rate	4,946 excess road traffic accidents	$39,539/accident	$195,557,697 (1.4%)	$118	^21^,^50^,^51
Indirect					$5,158,928,015	$1,143
Caregiving
Bottom-up: Estimated number of excess hours devoted to ADHD-related caregiving proportionally adjusted by the proportion of individuals with ADHD who require a caregiver and multiplied by the median hourly earnings in the US adult population	Children	$960/year	2,856,780	–	$2,743,758,996 (14.1%)	$960	^15
	Adolescents	$960/year	1,655,303		$1,589,815,281 (11.5%)	$960	^15
Unemployment
Bottom-up: Estimated excess unemployment to population ratio due to ADHD multiplied by the population of individuals with ADHD and the median annual earnings in the US by gender	Adolescents	Male: 3.3% Female: 1.0%	4,760	–	$79,743,577 (0.6%)	$48	^29^,^53^,^54^,^55
Productivity loss at work
Bottom-up: Estimated excess days lost due to ADHD-related absenteeism and presenteeism multiplied by the population of individuals with ADHD and the median annual earnings in the US by gender	Adolescents				$436,556,019 (3.2%)	$264	^53^,^54^,^55^,^56
	Absenteeism	13.6 days/year	210,059	–	$168,669,371 (1.2%)	–
	Presenteeism	21.6 days/year	210,059	–	$267,886,648 (1.9%)	–
Premature mortality
Bottom-up: Estimated number of excess all-cause deaths among adolescents with ADHD, applied to the average annual earnings and adjusted for the employment to population ratio per age group with a 3.0% discount rate	Adolescents	1.5 times the mortality rate	280	$14,713	$309,054,141 (2.2%)	$187	^54^,^55^,^57^,^58

Abbreviations. ADHD, attention-deficit/hyperactivity disorder; US, United States.

^aCalculated by the average cost differences between an individual with ADHD and an individual without ADHD or the general population (if data on individuals without ADHD was unavailable). Data for direct healthcare costs were obtained from IBM MarketScan Commercial and Medicaid Subsets from 01/01/2017 to 12/31/2018. Data for direct non-healthcare and indirect costs were estimated based on literature inputs.

^bCalculated as the excess number of days per year devoted to ADHD-related special education in children or adolescents with ADHD multiplied by the cost of one year of special education; the excess number of days per year of grade retention in children or adolescents with ADHD multiplied by the cost of one year of regular education in the US; and the cost of one year of ADHD-related disciplinary events in children or adolescents with ADHD.

Figure 1. Overall ADHD population in the US in 2018. Abbreviations. ADHD, attention-deficit/hyperactivity disorder; US, United States.

Figure 2. Excess economic burden of ADHD in (A) child and (B) adolescent populations in 2018, USD. Abbreviations. ADHD, attention-deficit/hyperactivity disorder; B, billion; M, million; US, United States; USD, United States dollar.

Figure 3. Excess economic burden per individual with ADHD in the US population in 2018, USD. Abbreviations. ADHD, attention-deficit/hyperactivity disorder; US, United States; USD, United States dollar.

Figure 4. Annual direct healthcare costs in (A) commercially insured and (B) Medicaid-insured children and adolescents with ADHD vs. without ADHD. Abbreviations. ADHD, attention-deficit/hyperactivity disorder; USD, United States dollar. ^aOutpatient costs also include costs of durable medical equipment.

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