Costing Adult Attention Deficit Hyperactivity Disorder

Daley, David; Jacobsen, Rasmus Højbjerg; Lange, Anne‐Mette; Sørensen, Anders; Walldorf, Jeanette

doi:10.1093/acprof:oso/9780198745556.001.0001

Cited by 18 publications

(13 citation statements)

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“…When considering cost-influencing factors beyond direct costs, criminality and loss of productivity are to be considered as well. Further, it is important to keep in mind that indirect costs add to the financial burden to both the patients themselves and to society [19]. Overall, more research in the general population using diagnostic instruments rather than only the patient's referral status to estimate gender and age differences in the comorbid conditions of ADHD over the lifespan is needed to complement our findings.…”

Section: Discussion Of Findingsmentioning

confidence: 90%

Direct medical costs of ADHD and its comorbid conditions on basis of a claims data analysis

Libutzki¹,

Ludwig²,

May³

et al. 2019

Eur. psychiatr.

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Background:ADHD is a highly prevalent disease in childhood which often persists into adulthood, then co-occurring with common adult conditions. Especially for adult ADHD, little is known about the costs of ADHD and the additional costs of comorbid conditions.Aims:To determine medical costs of ADHD and costs of comorbidities (mood, anxiety and substance use disorders, obesity), including their co-occurrence rates, stratified by age and gender.Method:Claims data from a German Statutory Health Insurance database with approximately four million member-records per year were analysed. A total of 25,300 prevalent ADHD patients were identified by means of an ICD-10 GM diagnosis of ADHD. A 1:1 age and gender adjusted reference group without ADHD diagnosis was randomly selected. Total health claims and health care costs related to ADHD were analysed, in addition to more targeted analyses of the occurrence and costs of pre-defined common comorbidities of, in particular, adult ADHD (SUD, mood and anxiety disorders, obesity). Outcomes were mean costs per patient and occurrence rates of comorbid conditions. Surplus costs of a comorbid condition in persons with ADHD relative to costs of this condition in persons without ADHD were calculated. Subgroup analyses were conducted based on age (0–12 years, 13–17 years, 18–30years, 30+ years) and gender.Results:Patients with ADHD were €1500 more expensive annually than individuals without ADHD (p < 0.001). Main cost drivers were inpatient care, psychiatrists and psychotherapists. Mood, anxiety, substance use disorders and obesity were significantly more frequent in ADHD patients and additional costs resulting from the comorbid conditions amounted up to €2800. Costs were slightly higher in women than men and increased with age for both genders. In young adults (18–30 years) health care costs dropped notably, especially costs for the medical treatment of ADHD with stimulants and costs for psychiatrists, before rising again in the group of patients over 30 years who had higher comorbidity rates.Conclusions:Medical costs for ADHD are substantial, in part through frequently occurring comorbid conditions, and particularly in adulthood, and are likely to further accelerate in the coming years. A gap of care was found, starting with the transition age group of patients over 17 years, as indicated by reduced costs per person during young adulthood, as well as an overall strong drop in administrative prevalence. In the future, approaches to improve the situation of care and reduce costs at the same time, i.e. through managed care programmes, should be implemented and benefit from detailed knowledge on age and gender-specific cost-drivers.

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Section: Discussion Of Findingsmentioning

confidence: 90%

Direct medical costs of ADHD and its comorbid conditions on basis of a claims data analysis

Libutzki¹,

Ludwig²,

May³

et al. 2019

Eur. psychiatr.

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“…Co‐morbidity is the rule in adult ADHD (Kooij et al, ) and untreated ADHD is high among AMHS attendees (Syed et al, ). Not only does this cause individual impairment and distress, but also significant costs for society, established in the United States (where health‐care costs account for only a quarter of total ADHD costs; Doshi et al, ) and in Denmark (where Danish Registry data indicate major costs are not in health care but sickness and early retirement benefits, traffic accidents and crime; Dalsgaard, Mortensen, Frydenberg, & Thomsen, ; Daley et al, ). There is therefore a strong economic argument for developing services with specialist expertise in working with adults with ADHD and (assuming that those experiencing most impairment will have been attending CAMHS) for optimizing transition from CAMHS to AMHS.…”

Section: Discussionmentioning

confidence: 99%

Transitioning from child and adolescent mental health services with attention‐deficit hyperactivity disorder in Ireland: Case note review

Tatlow‐Golden

Gavin

McNamara

et al. 2017

Early Intervention Psych

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KeywordsAttention-deficit hyperactivity disorder, ADHD, transition, child and adolescent mental health services, adult mental health services, CAMHS, AMHS ADHD transitions case note review Ireland Abstract AimIn a context of international concern about early adult mental health service provision, this study identifies characteristics and service outcomes of young people with attention-deficit hyperactivity disorder (ADHD) reaching the child and adolescent mental health service (CAMHS) transition boundary in Ireland. MethodsThe iTRACK study invited all 60 CAMHS teams in Ireland to participate; 8 teams retrospectively identified clinical case files for 62 eligible young people reaching the CAMHS transition boundary in all four Health Service Executive Regions. A secondary case note analysis identified characteristics, co-morbidities, referral and service outcomes for iTRACK cases with ADHD (n = 20). ResultsTwo-thirds of young people with ADHD were on psychotropic medication and half had mental health co-morbidities, yet none was directly transferred to public adult mental health services (AMHS) at the transition boundary. Nearly half were retained in CAMHS, for an average of over a year; most either disengaged from services (40%) and/or actively refused transfer to AMHS (35%) at or after the transition boundary. There was a perception by CAMHS clinicians that adult services did not accept ADHD cases or lacked relevant service/expertise. ConclusionsDespite high rates of medication use and comorbid mental health difficulties, there appears to be a complete absence of referral to publically available adult mental health services for ADHD youth transitioning from CAMHS in Ireland. More understanding of obstacles and optimum service configuration is essential to ensure that care is both available and accessible to young people with ADHD.

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“…These estimates therefore, although potentially useful for comparisons between disorders within the same healthcare system, should not be generalized to different contexts. The most comprehensive approach to calculate the total costs of ADHD in the Danish Psychiatric Central Register, showed that there is an economic burden of ADHD which is considerable and falls both on the individual and the state [337].…”

Section: Cost and Cost Effectivenessmentioning

confidence: 99%

Updated European Consensus Statement on diagnosis and treatment of adult ADHD

Bijlenga²,

et al. 2018

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Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

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Costing Adult Attention Deficit Hyperactivity Disorder

Cited by 18 publications

References 0 publications

Direct medical costs of ADHD and its comorbid conditions on basis of a claims data analysis

Direct medical costs of ADHD and its comorbid conditions on basis of a claims data analysis

Transitioning from child and adolescent mental health services with attention‐deficit hyperactivity disorder in Ireland: Case note review

Updated European Consensus Statement on diagnosis and treatment of adult ADHD

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