Association between societal costs and treatment response in children and adolescents with ADHD and their parents. A cross-sectional study in the Netherlands.

Annemarie Van Der Kolk,Saskia J Schawo,Leona Hakkaart-Van Roijen,Clazien Am Bouwmans,Jan K Buitelaar,Michel Van Agthoven

doi:10.1186/s40064-015-0978-7

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is associated with considerable burden of illness at a patient, family and societal level. Although pharmacological treatment is recommended by authoritative guidelines, evidence on its influence on the broader burden of illness is limited. As treatment induces costs, proper healthcare decision making requires evidence on the associated societal costs or benefits and particularly the difference that response to treatment can make.Data on ADHD related resource use of patients 8–18 years and parents were collected by means of a cross-sectional, online survey amongst members of the Dutch parent association. Children were stratified to responders and non-responders to treatment according to pre-defined expert definitions.Analyses were performed on 618 questionnaires (428 responders; 190 non-responders to treatment). Children were 11.8 years on average and mainly boys (82 %). Total monthly costs for children were €578 and €839 for responders and non-responders, respectively (p = 0.021), with a breakdown to direct medical costs (€322 vs. €512; p = 0.068), direct non-medical costs (€222 vs. €296; p = 0.090), and indirect non-medical costs (€34 vs. €57; p < 0.001). For parents, total costs were €246 vs. €399 for the responding and non-responding children, respectively (p = 0.006), with a breakdown to direct medical costs (€130 vs. €211; p = 0.010) and indirect non-medical costs (€116 vs. €181; p = 0.092). Total monthly costs of children and their parents together were €824 and €1228 for responders and non-responders to treatment, respectively (p = 0.002).These results stress the importance of a focus on response to treatment, not only beneficial for patients and their family, but also resulting in considerable societal benefits.

Highlights

Attention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous psychiatric disorder characterized by a chronic pattern of age-inappropriate inattention, hyperactivity and impulsivity with a worldwide-pooled prevalence of 5.3 % (Asherson 2004; Polanczyk et al 2007; Swanson et al 2009)
Several studies concluded that ADHD has a negative impact on family, school and environmental level reflected in a lower quality of life (QoL), increased use of healthcare resources and risk for injuries, substance abuse, delinquency, and driving violations van der Kolk et al SpringerPlus (2015) 4:224 (Danckaerts et al 2009; De Ridder & De Graeve 2006; Hakkaart-van Roijen et al 2007; Mannuzza et al 2008; Thompson et al 2007; van den Ban et al 2014; van der Kolk et al 2014)
Demographic characteristics Analyses were performed on 618 questionnaires of children and 590 questionnaires of parents (28 respondents – 4.5 % – did not complete all questions)

Summary

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous psychiatric disorder characterized by a chronic pattern of age-inappropriate inattention, hyperactivity and impulsivity with a worldwide-pooled prevalence of 5.3 % (Asherson 2004; Polanczyk et al 2007; Swanson et al 2009). The influence of ADHD on others than the patient is previously shown by productivity losses of parents and an increased use of healthcare resources by family members (Birnbaum et al 2005; Swensen et al 2003). Evidence is limited regarding the influence of treatment by medication on health care resource use of ADHD patients and their families, and the associated economic burden. This is a hindrance for the evaluation of the cost-effectiveness of current and future pharmacological interventions for ADHD (Le et al 2013)

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