Journal of the American Academy of Child & Adolescent Psychiatry
ReviewEconomic Impact of Childhood and Adult Attention-Deficit/Hyperactivity Disorder in the United States
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)
Peer functioning in children with ADHD
Ambul Pediatr
(2007)- et al.
Attention-deficit/hyperactivity disorder: increased costs for patients and their families
J Am Acad Child Adolesc Psychiatry
(2003) - et al.
The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study
J Am Acad Child Adolesc Psychiatry
(2009) - et al.
Attention-deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology
Ambul Pediatr
(2007) - et al.
The health economics of asthma and rhinitisI. Assessing the economic impact
J Allergy Clin Immunol
(2001) Diagnostic and Statistical Manual of Mental Disorders
(2000)- et al.
National Research Council (US) and Institute of Medicine (US) Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
(2009) Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children—United States, 2003 and 2007
MMWR Morb Mortal Wkly Rep
(2010)- et al.
Academic and educational outcomes of children with ADHD
Ambul Pediatr
(2007) - 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)
The impact of medications on quality of life in attention-deficit hyperactivity disorder: a systematic review
CNS Drugs
The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication
Am J Psychiatry
A systematic review of global publication trends regarding long-term outcomes of ADHD
Front Psychiatry
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
A review of the economic burden of ADHD
Cost Eff Resour Alloc
The economic impact of attention-deficit/hyperactivity disorder in children and adolescents
J Pediatr Psychol
Economic implications of attention-deficit hyperactivity disorder for healthcare systems
Pharmacoeconomics
Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2
Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care
Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning
J Int Neuropsychol Soc
Economic burden and comorbidities of attention-deficit/hyperactivity disorder among pediatric patients hospitalized in the United States
Child Adolesc Psychiatry Ment Health
Impact of ADHD on school systems
Healthcare cost for children with attention-deficit/hyperactivity disorder
Econ Neurosci
A comparison of service use and costs among adults with ADHD and adults with other chronic diseases
Psychiatr Serv
Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder
JAMA
Incremental employee health benefit costs, absence days, and turnover among employees with ADHD and among employees with children with ADHD
J Occup Environ Med
Service use patterns for adolescents with ADHD and comorbid conduct disorder
J Behav Health Serv Res
Long-term consequences of childhood ADHD on criminal activities
J Ment Health Policy Econ
Young adult outcomes of children with hyperactivity: leisure, financial, and social activities
Int J Disabil Dev Educ
Cited by (325)
Prospective associations between ADHD symptoms and physical conditions from early childhood to adolescence: a population-based longitudinal study
2023, The Lancet Child and Adolescent HealthThe global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses
2023, Journal of Affective DisordersA better cost:benefit analysis yields better and fairer results: EPA's lead and copper rule revision
2023, Environmental ResearchHormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder
2023, Journal of the American Academy of Child and Adolescent Psychiatry
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.