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Economic Burden and Service Utilization of Children With Attention-Deficit/Hyperactivity Disorder: A Systematic
Mitchell Dodds1, Sithara Wanni Arachchige Dona1, Lisa Gold1
1Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
Insights
Children with attention-deficit/hyperactivity disorder (ADHD) use more services and incur higher costs. However, many still face unmet health needs, indicating a need for improved access to effective ADHD care.
Area of Science:
- Pediatric Neurodevelopmental Disorders
- Health Services Research
- Healthcare Economics
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children, significantly impacting their health and educational trajectories.
- Understanding the economic burden and service utilization patterns associated with childhood ADHD is crucial for effective healthcare policy and resource allocation.
Approach:
- Systematic literature synthesis of 32 peer-reviewed studies published between 2007 and 2023.
- Inclusion of studies from 9 databases, with rigorous title/abstract and full-text screening by two independent reviewers.
- Meta-analysis focused on direct medical costs and comprehensive analysis of societal costs.
Key Points:
- Children with ADHD demonstrate higher utilization of pharmaceuticals, mental health, and special education services compared to their peers.
- Despite increased service use, a significant proportion of children with ADHD experience unmet health needs.
- Annual health system costs are substantially higher for children with ADHD, ranging from $722-$11,555, compared to $179-$3646 for counterparts.
Conclusions:
- Childhood ADHD is associated with elevated service utilization and significant direct and societal economic costs.
- The findings highlight a critical gap in care, with unmet needs persisting despite increased service engagement.
- Policy interventions aimed at enhancing access to comprehensive and effective ADHD services are essential to mitigate the disorder's impact.
Objectives:
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. This study aims to systematically synthesize the literature on service utilization and costs for children with ADHD.
Methods:
The search included 9 databases for peer-reviewed primary studies in English from 2007 to 2023. Two independent reviewers conducted title/abstract and full-text screenings and quality assessment. Meta-analysis was conducted on direct medical costs.
Results:
Thirty-two studies were included. Children with ADHD have used more pharmaceuticals, mental health, and special education services than children without ADHD (counterparts). Nevertheless, one study found that children with ADHD were twice as likely to have unmet health needs than their counterparts. Annual health system costs per patient were highly varied and higher in children with ADHD ($722-$11 555) than their counterparts ($179-$3646). From a societal perspective, children with ADHD were associated with higher costs ($162-$18 340) than their counterparts ($0-2540). The overall weighted mean direct medical cost was $5319 for children with ADHD compared with $1152 for their counterparts when all studies with different sample sizes were considered together, with the difference being $4167. Limited literature on productivity losses associated with ADHD reported them as a substantial cost. ADHD in children had a "large" effect on the increment of direct medical costs.
Conclusions:
ADHD was associated with increased service utilization and costs. However, unmet health needs or underuse among children with ADHD was also evident. Governments should endeavor to improve access to effective services for children with ADHD to mitigate the impact of ADHD.
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