PMH22 Economic Burden of Attention Deficit Hyperactivity Disorder in Children and Adolescents in Europe

Abstract

This comprehensive review was conducted to report existing evidence from published studies evaluating the economic burden of attention deficit hyperactivity disorder (ADHD) in children and adolescents in Europe. A systematic search of electronic literature databases (EMBASE and MEDLINE), was conducted from January 2001 to June 2011 to identify economic studies on ADHD in children and adolescents in Europe. All economic studies in English language, regardless of design and intervention were included. Eligibility of trials was assessed by two reviewers with any discrepancy reconciled by a third, independent reviewer. A total of 591 citations were retrieved out of which eight met pre-defined inclusion criteria. Five studies were cost-analyses while three were cost-effectiveness analyses. In Germany, the total direct costs for ADHD were €158 million in 2002 which increased to €287 million in 2006 with inpatient treatment costs comprising approximately 40% of the total direct costs in 2006 (Wehmeier 2009). Other contributors to total direct costs included hospitalisations, special health-care services, comorbidities, and physician visits (Ridder 2006). The total projected costs of ADHD in Germany during 2012 are estimated to be €311 million (Schlander 2007). The mean annual direct medical costs of ADHD patients with psychiatric comorbidities were €5908 compared to €974 for ADHD alone in the The Netherlands (Roijen 2007). The cost-effectiveness studies retrieved primarily focused on atomoxetine (ATX) and methylphenidate (MPH). ATX was found to be more cost-effective than MPH in the UK (ICER of £15 224 per QALY gained) (Cottrell 2008) as well as in Spain (ICER of €34 308 per QALY gained) (Hong 2009). ADHD is associated with substantial fiscal burden in Europe. Since 2002, a trend of increase in direct costs has been observed which may be due to increasing demand for healthcare services, and presence of comorbidities.