Abstract
Background: Adult attention-deficit hyperactivity disorder (ADHD) is a chronic, costly and debilitating disorder. In South Africa (SA), access to funding for care and treatment of ADHD is limited, and research is lacking.Aim: This study aimed to establish the current situation with regard to the psychiatric management of and funding for treatment of adult ADHD in the private sector in SA.Methods: A diagnostically refined retrospective claims database analysis was conducted. We examined the prevalence, costs and funding profile of claims over a 2-year period for adult beneficiaries with possible ADHD of a large medical administrator in SA.Results: The prevalence of adult ADHD was lower than published international rates. The presence of adult ADHD increased the prevalence of comorbidity and doubled the health care costs of beneficiaries. Contrary to public belief, comorbidities (including their medicine costs) rather than psychiatric services or medicines were the main cost drivers.Conclusion: The current private health insurance funding model for ADHD limits access to funding. This affects early diagnosis and optimal treatment, thereby escalating long-term costs. Improved outcomes are possible if patients suffering from ADHD receive timely and accurate diagnosis, and receive chronic and comprehensive care. Balanced regulation is proposed to minimise the risk to both medical schemes and patients. A collaborative approach between stakeholders is needed to develop an alternative cost-effective funding model to improve access to treatment and quality of life for adults with ADHD in SA.
Highlights
Attention-deficit hyperactivity disorder (ADHD) has received increased scientific, clinical and public attention over the past few decades
We report on findings on the quantitative analysis of a retrospective claims database using medical data, pharmacy data and enrolment information as captured for the largest administrator of medical schemes in South Africa (SA), representing 3 million beneficiaries (29% of all beneficiaries across 17 medical schemes)
For the period under investigation, the total number of beneficiaries managed by the medical scheme administrator in the age group under investigation was 1 390 654
Summary
Attention-deficit hyperactivity disorder (ADHD) has received increased scientific, clinical and public attention over the past few decades. ADHD is a costly, chronic disorder, with significant impact on the quality of life (QOL) of patients and their families. The burden of disease (BOD) is significant, with the disabilityadjusted life years (DALYs) calculated as 424 per 100 000.3 Comorbidity, estimated at more than 50% with ADHD, contributes to the BOD and reduced QOL of patients with ADHD.[4,5]. In an analysis of all medical, pharmaceutical and disability claims in an administrative database (N > 100 000), resource utilisation of individuals with ADHD and their family members was contrasted with a matched control sample of patients without ADHD. Adult attention-deficit hyperactivity disorder (ADHD) is a chronic, costly and debilitating disorder. In South Africa (SA), access to funding for care and treatment of ADHD is limited, and research is lacking
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