Monday, February 9, 2009

The Economic Impact of ADHD

Since the economy seems to be on everyone's mind these days, I wanted to shift gears for a couple of posts and briefly discuss some of the economic impacts of ADHD. In this post, we will begin by reviewing some articles on the approximate cost that untreated ADHD bears on society. In the next one, we will review a paper on what (in general) are the most cost-effective treatment options for ADHD.

Direct and indirect costs associated with ADHD. There was an excellent review done by Bernfort and colleagues on ADHD from a socio-economic perspective, which investigated the effects of costs such as increased educational expenses, costs of addressing drug and substance abuse (which is higher in ADHD individuals than the general population), increased traffic accidents, employment costs (such as loss of productivity), health care costs (which cover both prescription drugs as well as therapy, as well as increased medical costs from high-risk behavior, which is also more common in individuals with ADHD), as well as a few others. The importance of this study was to shed light on some of the far-reaching implications of the ADHD and the surmounting costs associated with them.

Another review article by Pelham and coworkers attempted to put a price tag on these different factors and behaviors. The review, which investigates costs associated with pediatric and adolescent ADHD, and factors in issues such as education (and special educational needs), loss of work to parents of ADHD children, impacts on the juvenile justice system as well as health-care costs, placed the overall cost per individual with ADHD to be almost $15,000 annually! While I personally view this number as being a bit high, I believe that the sheer magnitude of this number is extremely telling, and an important indicator for the need for proper treatment for children and young adults with the disorder.

We have spent a number of pages investigating the high heritability of the disorder by investigating the genetic components of ADHD. Given this fact, family studies and the economic impact of the disorder of ADHD on families should be especially relevant. From a study (note that this was done by Eli Lilly, so please consider the source) on medical claims found a 2 to 3-fold higher cost of claims and payouts to family members of ADHD. These number suggest the significant burdens that can be placed on both family members and their health care providers surrounding their relationship with ADHD individuals. Keep in mind that the genetic component of ADHD is often believed to be somewhere around 75% (and some studies place it as high as 90%), so the likelihood of multiple cases of ADHD in a single family is also high. Not surprisingly, the financial burden is another facet of the disorder which can act as another source of stress on parents and other family members of ADHD children, especially during more difficult economic times.

Finally, claims data from individuals with ADHD and their family members was obtained from a single large company in the US, and an attempt was made to extrapolate the data to the American population as a whole (which is a big if, but may be at least indicative of the whole population, if the makeup of this company is even close to being representative of the US population as a whole). Taking into account factors such as health care and work loss costs involved with the individuals with ADHD and their families, this study estimated a total excess (meaning above the average non-ADHD person) cost to be over 30 billion dollars a year. Breaking this down amongst the individuals with the disorder (which, using a relatively conservative estimate of 5% of the US population, which would put around 15 million individuals as having the disorder), this would amount to around $2,000 per person. This falls somewhere in between the numbers tossed around by some of the other studies.

Again, keep in mind that this data is extrapolated from a small portion of the American population, which, statistically, is often a dangerous thing to do. However, just the sheer magnitude of these numbers, especially when we begin to see some degree of numerical overlap between economic estimates from different studies on the costs associated with treating or dealing with the disorder of ADHD should be eye-opening, even if there is still a fair amount of ambiguity involved among some of these figures. Since most of these studies place the direct and indirect economic impacts of the disorder to be in the thousands (and in some cases 10 thousands) per person, we can see the importance of treating the disorder and its potential economic impacts on society as a whole. In the next post, we will investigate the cost-effectiveness of different measures in treating ADHD (along with some of the common comorbid or co-existing disorders).

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