Review
Economic Impact of Childhood and Adult Attention-Deficit/Hyperactivity Disorder in the United States

https://doi.org/10.1016/j.jaac.2012.07.008Get rights and content

Objective

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders in children in the United States and often persists into adulthood with associated symptomatology and impairments. This article comprehensively reviews studies reporting ADHD-related incremental (excess) costs for children/adolescents and adults and presents estimates of annual national incremental costs of ADHD.

Method

A systematic search for primary United States-based studies published from January 1, 1990 through June 30, 2011 on costs of children/adolescents and adults with ADHD and their family members was conducted. Only studies in which mean annual incremental costs per individual with ADHD above non-ADHD controls were reported or could be derived were included. Per-person incremental costs were adjusted to 2010 U.S. dollars and converted to annual national incremental costs of ADHD based on 2010 U.S. Census population estimates, ADHD prevalence rates, number of household members, and employment rates by age group.

Results

Nineteen studies met the inclusion criteria. Overall national annual incremental costs of ADHD ranged from $143 to $266 billion (B). Most of these costs were incurred by adults ($105B−$194B) compared with children/adolescents ($38B−$72B). For adults, the largest cost category was productivity and income losses ($87B−$138B). For children, the largest cost categories were health care ($21B−$44B) and education ($15B−$25B). Spillover costs borne by the family members of individuals with ADHD were also substantial ($33B−$43B).

Conclusion

Despite a wide range in the magnitude of the cost estimates, this study indicates that ADHD has a substantial economic impact in the United States. Implications of these findings and future directions for research are discussed.

Section snippets

Method

A systematic review was conducted using guidelines from the Cochrane Handbook for Systematic Reviews of Interventions.14 Four large databases (MEDLINE, EMBASE, ERIC, and PsycINFO) were searched for articles published from January 1, 1990 through June 30, 2011 using the following abstracted search strategy: (terms describing ADHD) AND ((terms describing cost analysis or economic impact) OR (terms describing areas of cost due to ADHD)). An extensive list of terms describing cost areas of interest

Results

The initial literature search identified 4,580 citations. After the screening process, only 19 studies met all inclusion criteria (Figure S1, available online). Table 110, 23, 24, 25, 26, 27, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45 lists the key characteristics of these 19 studies. Eleven studies examined costs incurred by children with ADHD or their family members and 10 studies examined costs incurred by adults with ADHD or their family members (two studies examined

Discussion

This review included 19 studies examining the incremental costs of ADHD in the United States. Recognizing the variance introduced by heterogeneous methodologies across these studies, the range of costs rather than point estimates was calculated. Despite a wide range in the annual national incremental costs computed in the present analysis (overall $143B−$266B), the lower end estimate alone indicates that ADHD has a substantial economic impact in the United States. Although large in magnitude,

References (59)

  • D. Coghill

    The impact of medications on quality of life in attention-deficit hyperactivity disorder: a systematic review

    CNS Drugs

    (2010)
  • R.C. Kessler et al.

    The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication

    Am J Psychiatry

    (2006)
  • P. Hodgkins et al.

    A systematic review of global publication trends regarding long-term outcomes of ADHD

    Front Psychiatry

    (2011)
  • H.G. Birnbaum et al.

    Costs of attention deficit-hyperactivity disorder (ADHD) in the US: excess costs of persons with ADHD and their family members in 2000

    Curr Med Res Opin

    (2005)
  • L.S. Matza et al.

    A review of the economic burden of ADHD

    Cost Eff Resour Alloc

    (2005)
  • W.E. Pelham et al.

    The economic impact of attention-deficit/hyperactivity disorder in children and adolescents

    J Pediatr Psychol

    (2007)
  • C.L. Leibson et al.

    Economic implications of attention-deficit hyperactivity disorder for healthcare systems

    Pharmacoeconomics

    (2003)
  • J.P.T. Higgins et al.

    Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2

    (2009)
  • Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care

    (2009)
  • R.A. Barkley et al.

    Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning

    J Int Neuropsychol Soc

    (2002)
  • J. Meyers et al.

    Economic burden and comorbidities of attention-deficit/hyperactivity disorder among pediatric patients hospitalized in the United States

    Child Adolesc Psychiatry Ment Health

    (2010)
  • S. Forness et al.

    Impact of ADHD on school systems

  • K.J. Kelleher et al.

    Healthcare cost for children with attention-deficit/hyperactivity disorder

    Econ Neurosci

    (2001)
  • J.A. Hinnenthal et al.

    A comparison of service use and costs among adults with ADHD and adults with other chronic diseases

    Psychiatr Serv

    (2005)
  • C.L. Leibson et al.

    Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder

    JAMA

    (2001)
  • N.L. Kleinman 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)
  • D.E. Jones et al.

    Service use patterns for adolescents with ADHD and comorbid conduct disorder

    J Behav Health Serv Res

    (2009)
  • J. Fletcher et al.

    Long-term consequences of childhood ADHD on criminal activities

    J Ment Health Policy Econ

    (2009)
  • M. Fischer et al.

    Young adult outcomes of children with hyperactivity: leisure, financial, and social activities

    Int J Disabil Dev Educ

    (2006)
  • Cited by (325)

    View all citing articles on Scopus

    This work was funded by Shire Development LLC. Dr. Doshi's consultancy work on this project was supported by Shire Development LLC.

    The authors thank Dr. Joshua T. Cohen, Tufts Medical Center, for his helpful comments on an earlier draft of this article.

    Disclosure: Dr. Doshi has served as a consultant to Shire, Forest, and Bristol-Myers Squibb, has received research support from Pfizer, and reports stock ownership in Merck and Co. Dr. Kahle has received consultancy fees from Shire. Drs. Hodgkins, Sikirica, Erder, and Setyawan report stock ownership in Shire and/or have been granted Shire stock options. Dr. Neumann is the founding director of the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry, a publicly available database of published cost-utility analyses. The database has been supported through a variety of grants from the Agency for Health Research and Quality, the National Library of Medicine, and the National Science Foundation. It also receives unrestricted grant funding from external sponsors listed on the registry's website (http://www.cearegistry.org), including Amgen, Bayer Healthcare, Biogen, Bioscience, Boston Scientific, Covidien, Daichi-Sankyo, EMD Serono, Endo, Express-Scripts, GE Healthcare, Johnson and Johnson, Lundbeck SA, Medtronic, Merck, Millennium, Novartis, Teva North America, Shire, and Pfizer. Mr. Cangelosi reports no biomedical financial interests or potential conflicts of interest.

    Clinical guidance is available at the end of this article.

    This article is discussed in an editorial by Dr. A. Reese Abright on page 987.

    Supplemental material cited in this article is available online.

    View full text