Recently Published Economic Analysis Highlights the Financial Impact of Attention-Deficit/Hyperactivity Disorder (ADHD) in the United States (US)
PHILADELPHIA, October 26, 2012 /PRNewswire/ –
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
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
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
ADHD is one of the most common childhood psychiatric disorders. 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). 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. 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. When this percentage is extrapolated to the full US population aged 18 and
over, approximately 10 million adults are estimated to have ADHD.
The specific etiology of ADHD is unknown, and there is no single diagnostic test for
this disorder. 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(R)) or International Classification of Diseases, Tenth Revision
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.
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:
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uncertainties include, but are not limited to, risks associated with: the inherent
uncertainty of research, development, approval, reimbursement, manufacturing and
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third-party reimbursement for its products; and other risks and uncertainties detailed
from time to time in the Company’s filings with the Securities and Exchange Commission.
1) Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision (DSM-IV-TR(R)). 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/. [http://www.census.gov/popest ] Accessed August 16, 2012.
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