Loss of Workplace Productivity and Income Contribute 70 Percent to 80 Percent of Overall Excess Costs in Adults with ADHD and Adult Family Members of Patients with ADHD
Philadelphia, US – October 26, 2012 – A recently published systematic literature review and analysis of applicable studies has assessed the economic impact of ADHD in the United States. This analysis estimated that annual national excess costs for ADHD ranged from $143 billion to $266 billion. More than 70 percent of these overall excess costs were attributable to adults with ADHD or to adult family members of patients with ADHD. The analysis was published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
This analysis was designed and conducted by health economists from Tufts Medical Center, the University of Pennsylvania and the Global Health Economics & Outcomes Research group at Shire Specialty Pharmaceuticals. To date, this is the most comprehensive analysis of published data relating to incremental - or excess - costs of ADHD across age groups, including children, adolescents and adults. Incremental costs included those associated with overall healthcare, productivity and income losses, and the educational and judicial systems.
For individuals with ADHD, the excess costs for each category were estimated by comparing the relevant costs against those of individuals who were not diagnosed with ADHD. For family members of individuals with ADHD, costs were compared to those of individuals who did not have a family member with ADHD. The excess costs were then extrapolated to the entire US population using established scientific methodologies.
The analysis estimated that the national excess costs for adults with ADHD or adult family members of patients with ADHD were almost three times higher than for children and adolescents with ADHD. Workplace productivity and income losses were the largest contributors to the economic burden associated with adults with ADHD, ranging from $87 billion to $138 billion and accounting for more than 70 percent to 80 percent of the overall costs in adults.
In children and adolescents with ADHD, the economic burden was also substantial, ranging from $38 billion to $72 billion. The largest cost categories were healthcare costs, ranging from $21 billion to $44 billion annually, and education costs, ranging from $15 billion to $25 billion annually.
The analysis did not evaluate the impact of treatment interventions on excess costs due to the lack of available data. In addition, insufficient studies were available to assess the economic burden of traffic accidents and substance abuse in this population.
“ADHD is often perceived as a childhood disease, but this analysis demonstrates that at a national level, the economic impact of ADHD on adults may be larger than that on children,” says Peter Neumann, ScD, director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, and Professor of Medicine at Tufts University School of Medicine. “Additional research to understand and quantify the potential impact of treatment of ADHD in all age groups is needed.”
About the Analysis
A systematic literature search for primary US-based studies published between January 1, 1990 and June 30, 2011 on costs among children/adolescents and adults with ADHD and their family members was conducted. Only studies in which mean annual incremental costs per ADHD individual above non-ADHD controls were reported or from which these costs could be calculated were included. This analysis also estimated the costs associated with incremental losses due to lower wages or unemployment, as well as loss of overall productivity of adults with ADHD. Per-person incremental costs were adjusted to 2010 US dollars and converted to annual national incremental costs of ADHD based on 2010 US census population estimates, ADHD prevalence rates, number of household members and employment rates by age group. The initial literature search identified 4,580 citations. Nineteen studies met the inclusion criteria.
Educational costs included costs related to special education, counseling, disciplinary incidents, and occupational, speech and physical therapy. Costs related to the judicial system included costs relating to arrest and detention center expenditures, and costs to the victims of crimes. The analysis computed the estimated overall annual incremental per-patient costs and the incremental costs of ADHD in the US at a national level. Estimated incremental costs were also calculated by age group, cost sectors and patient versus family.
Overall estimated productivity losses for adults aged 18 to 64 with ADHD ranged from $209 to $6,699 annually per person across six studies in the review. These estimates included productivity loss due to absenteeism, presenteeism (poor performance while at work), disability payments and/or workers’ compensation. In the nine studies that estimated income and productivity losses, annual incremental costs ranged from approximately $88 billion to $141 billion among adults aged 18 to 64 at a national level.
Healthcare costs ranged from $37 billion to $94 billion across all age groups and constituted only one-quarter to one-third of the overall incremental costs associated with ADHD.
According to the analysis, family members of children and adults with ADHD were also affected economically by the patient’s disorder. Incremental costs that were passed on to family members of people with ADHD, also known as spillover costs, were a substantial proportion of total ADHD costs (between 16 percent and 23 percent), ranging from $33 billion to $43 billion.
Some analysis limitations included the varied characteristics of the studies assessed, such as setting, design, time and measured cost components. Also, there may have been a disparity in controlling for comorbidities commonly associated with ADHD, as the incremental costs of ADHD without comorbidities were not available for every study, so the costs of ADHD alone may have been overestimated. Additionally, the prevalence of ADHD has been reported to be increasing over time. It is not known whether this is because the incidence of ADHD itself has increased or if the recognition and diagnosis of ADHD has increased over time. Whether it is the former or latter, this reported increasing prevalence could have contributed to lower or higher incremental costs of ADHD than estimated. Furthermore, this analysis assessed the average economic impact of ADHD at the national level; however, costs in individual states may be higher or lower.
This analysis was funded by Shire Development LLC.
Attention-Deficit/Hyperactivity Disorder is a neurobehavioral disorder that manifests as a persistent pattern of inattention and/or hyperactivity-impulsivity and is more frequent and severe than is typically observed in individuals at a comparable level of development.1,2
ADHD is one of the most common childhood psychiatric disorders.3 In the United States, the estimated prevalence of parent-reported ADHD is approximately 9.5 percent or 5.4 million of all school-age children diagnosed with ADHD at some point in their lives, according to the Centers for Disease Control and Prevention (CDC).4 Although many people tend to think of ADHD as a childhood problem, 60 percent to 85 percent of children with ADHD may continue to meet the criteria for the disorder during their teenage years. Nearly 50 percent of children with ADHD may continue to meet the criteria for the disorder in adulthood, based on parent report.3 The disorder is estimated to affect 4.4 percent of US adults aged 18 to 44 based on results from the National Comorbidity Survey Replication.5 When this percentage is extrapolated to the full US population aged 18 and over, approximately 10 million adults are estimated to have ADHD.6
The specific etiology of ADHD is unknown, and there is no single diagnostic test for this disorder.3 Adequate diagnosis requires the use of medical and special psychological, educational, and social resources, utilizing diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR®) or International Classification of Diseases, Tenth Revision (ICD-10).1,2,3
Although there is no cure for ADHD, there are accepted treatments that have been demonstrated to improve symptoms. Standard treatments include educational approaches, psychological therapies which may include behavioral modification, and/or medication.3
For further information please contact:
Gwen Fisher (Specialty Pharma)
+1 484 595 9836
Shire’s strategic goal is to become the leading specialty biopharmaceutical company that focuses on meeting the needs of the specialist physician. Shire focuses its business on attention deficit hyperactivity disorder, human genetic therapies, gastrointestinal diseases and regenerative medicine as well as opportunities in other therapeutic areas to the extent they arise through acquisitions. Shire’s in-licensing, merger and acquisition efforts are focused on products in specialist markets with strong intellectual property protection and global rights. Shire believes that a carefully selected and balanced portfolio of products with strategically aligned and relatively small-scale sales forces will deliver strong results.
For further information on Shire, please visit the Company’s website: www.shire.com.
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1. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision (DSM-IV-TR®). Arlington, VA: American Psychiatric Publishing; 2000:85-93.
2. International Classification of Diseases, Tenth revision, (ICD-10). World Health Organization; 2007: Chapter 5, F90. http://www.who.int/classifications/apps/icd/icd10online/. Accessed August 16, 2012.
3. Pliszka S and the AACAP Work Group on Quality Issues. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921.
4. Attention-Deficit / Hyperactivity Disorder (ADHD). Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/ncbddd/adhd/data.html/. Accessed August 16, 2012.
5. Kessler RC, Adler L, Barkley R, et al. The Prevalence and Correlates of Adult ADHD in the United States: Results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716-723.
6. Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2009 (NC-EST2005-02). Population Division, US Census Bureau 2009;1-4. http://www.census.gov/popest/. Accessed August 16, 2012.