Table 1.
Studies of the Direct Costs of ADHD
| Citation | Sample | Data Sources (Time Period) | Findings1 |
| Birnbaum et al. 2005 | Treated ADHD patients aged 7–44 (N = 1219) and their family members under age 65 (N = 3692); controls without ADHD matched to both patients (N = 1219) and family members (N = 3692) on age, gender, employment status, geographical location age, gender, state of residence, and employment status) | Claims data from large Fortune 100 company (1996–1998) | This study estimated total excess costs for the US population, defined as the difference between ADHD patients/family members and controls. Annual mean direct ADHD treatment costs (2004 US $) were $674/$745 for girls/boys with ADHD (excess costs = $0.53/$1.06 billion) and $412/$529 for female/male adults with ADHD (excess costs = $0.13/$0.40 billion). Annual other direct treatment costs (2004 US $) were $865/$990 for girls/boys (excess costs = $0.80/$2.0 billion) and $2609/$3022 for female/male adults with ADHD (excess costs = $0.67/$1.46 billion). |
| Burd et al. 2003a | Children aged 0–21 years with ADHD (N = 3,872) and non-matched controls (N = 95,119) without ADHD | North Dakota Health Claims Database (1996–1997) | Annual, mean direct treatment costs (2004 US $) were $870 for ADHD patients versus $663 for controls; 1.9% of total annual health expenditures in North Dakota attributable to ADHD. |
| Chan et al. 2002 | Children aged 5–20 years with ADHD (N = 165), asthma (N = 322) or neither diagnosis (N = 4,952) | Nationally representative household survey data (1996) | Annual, incremental direct treatment costs (2004 US $) were $661 for children with ADHD (P < 0.001) and $603 for children with asthma (P < 0.01) (relative to costs for children with neither diagnosis) |
| Guevara et al. 2001 | Children aged 3–17 years with ADHD (N = 2992) and matched (on age and sex) controls (N = 11,968) without ADHD | Health maintenance organization in western Washington State (1997) | Annual, incremental direct treatment costs (2004 US $) were $503 (95% CI: $450–552) for children with ADHD alone and $1088 (95% CI: $899–$1,304) for children with ADHD plus coexisting mental health disorders (relative to costs for children with no ADHD) |
| Kelleher et al. 2001 | Children aged 7–20 years with ADHD (N = 1,602) and with asthma (N = 1,411) | Medicaid claims data for patients in Pittsburgh, PA and surrounding counties (1994–1995) | Annual, mean (± SD) direct treatment costs (2004 US $) were $2,567 ± $2,959 for the ADHD group versus $2,382 ± $2,664 for the asthma group (difference not statistically significant) |
| Leibson et al. 2001 | Children aged 5–19 years with ADHD (N = 309) and non-matched controls (N = 3,810) without ADHD | Rochester, Minnesota medical facility-linked billing data system (1987–1995) | Long-term (9 year), median direct treatment costs (2004 US $) for ADHD patients compared with those without ADHD were more than double ($6,158 vs. $2,780; P < 0.001), even for the subset with no hospital or emergency room admissions ($183 vs. $93; P < 0.001) |
| Leslie et al. 2001 | Children aged ≤ 17 years with use of mental health services, including patients with hyperactivity (N~10,000) | Health care claims for privately insured population (MarketScan®) (1993–1996) | Annual inpatient costs (2004 US $) per treated hyperactive patient declined from $26,550 in 1993 to $8,644 in 1996 (P < 0.001); there was also a significant decline in outpatient treatment costs ($931 and $659, respectively, P < 0.001) |
| Mandell et al. 2003 | Children aged 3–15 years with ADHD (N = 4,306) and with no psychiatric disorder (N = 60,975) | Medicaid claims data for patients in Philadelphia, PA (1993–1996) | Long-term (3 year), mean direct treatment costs (2004 US $) were $4,891 for ADHD patients versus $221 for patients with no psychiatric disorder |
| Marchetti et al. 2001 | Hypothetical cohort of school-aged children with ADHD | Literature review, managed care survey, clinical experts (2000–2001) | Average, total annual expected cost (2001 US $) per treated patient was $1,710 for Metadate CD, $1876 for Concerta, $2,061 for methylphenidate immediate-release/extended release (MPH IR/ER), $2,122 for MPH IR, $2,392 for Ritalin, and $2,567 for Adderall. |
| Secnik et al. 2005b | Adults aged 18–64 with ADHD (N = 2,252) and matched controls without ADHD (N = 2252; matched on age, gender, metropolitan statistical area, and type of insurance coverage) | Health care claims for privately insured population (MarketScan®) (1999–2001) | Controlling for the impact of comorbidities, adults diagnosed with ADHD had significantly (P < 0.0001) higher outpatient costs ($3,009 vs. $1.491), inpatient costs ($1,259 vs. $514), prescription drug costs ($1,673 vs. $1,008) and total annual medical costs ($5,651 vs. $2,771) compared with matched controls without ADHD |
| Swensen et al. 2003 | Children aged 0–18 years with ADHD (N = 1,086) and matched (on age, gender, and state of residence) controls (N = 1,086) without ADHD | Claims data from large Fortune 100 company (1996–1998) | Annual, mean (± SD) direct treatment costs (2004 US $) were $2,046 ± $3,474 for the ADHD group versus $703 ± $2,215 for matched controls without ADHD (P < 0.0001). |
| Swensen et al. 2004 | Individuals aged 0–64 with ADHD (N = 1,308) and matched (on age, gender, state of residence, and employment status) controls (N = 1,308) without ADHD | Claims data from large Fortune 100 company (1996–1998) | Annual, mean direct treatment costs (2004 US $) were $1,797 for children with ADHD versus $577 for matched controls without ADHD (P < 0.05); $2,230 for adolescents with ADHD versus $783 for matched controls without ADHD (P < 0.05); and $4,929 for adults with ADHD versus $1,473 for matched controls without ADHD (P < 0.05). |
1All costs updated to Year 2004 US $ using the Medical Services component of the Consumer Price Index (for US-based studies). For non-US studies, all country-specific costs first updated to Year 2004 currency values based on country-specific inflators; and then converted to Year 2004 US$ based on currency exchange rates.
MPH = methylphenidate
IR = immediate release
ER = extended release