Direct medical and indirect absenteeism costs among working adult ADHD patients in the United States

ABSTRACT

Objective

This study investigated the direct medical and indirect (i.e. absenteeism) costs among working adults diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) in the United States.

Methods

This study utilized 2017–2018 Medical Expenditure Panel Survey data. Attribution and regression-based incremental cost approaches were utilized to estimate direct medical costs, i.e. prescription drug costs and total costs. The regression-based approach was utilized to estimate absenteeism cost.

Results

The study sample consisted of 32,222 observations (weighted: 187,207,896). Of these, 459 (weighted: 3,175,033) had ADHD. The mean annual per person ADHD-attributable prescription drug cost was 2018 US $1,248 (standard error (SE): 97) and the ADHD-attributable total cost was $2,031 (SE: 371). This contributed to a mean overall annual spending of $3.96 (SE: 0.42) billion on ADHD-attributable prescription drugs and $6.45 (SE: 1.26) billion on ADHD-attributable total direct medical costs among adult ADHD patients. Based on the regression-based approach, the mean annual incremental cost for ADHD was $1,641 (SE: 164) and $4,328 (SE: 862) per person for prescription medication costs and total costs, respectively. The mean indirect cost of ADHD was estimated at $512 (SE: 91) per year, per person among working adults with ADHD in the United States.

Conclusions

There is a significant direct and indirect economic burden on working adults with ADHD.

Expert opinion

There is a significant economic burden of ADHD in terms of direct medical (including out-of-pocket) cost as well as indirect absenteeism cost. The per person annual costs estimated using a regression approach were approximately twice as much as the costs using the sum disease-specific approach, suggesting a potential role for ‘spillover’ costs among working adults with ADHD. Prescription drug costs were top-ranked contributors to the direct medical costs. As a group, working adults with ADHD are relatively understudied and more research is needed to better understand the burden of ADHD in this group.

KEYWORDS:

• ADHD
• adult ADHD
• Attention-Deficit/Hyperactivity Disorder
• direct medical cost
• indirect cost
• Medical Expenditure Panel Survey
• productivity cost

Author contributions

C Shah developed the original idea, designed the analytical model, performed statistical analyses, and wrote the first version of the manuscript. E Onukwugha helped develop the research idea, provided supervision on analytic methods, and contributed to revising the manuscript. All authors contributed to the manuscript writing and development. All authors have approved the final version of the manuscript .

Declaration of interest

E Onukwugha reports grants from BeiGene Ltd., grants from Pfizer, Inc., outside this submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

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

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2022.2073223

Additional information

Funding

This paper was not funded.