To determine the financial and non-financial costs of Attention-Deficit/Hyperactivity Disorder (ADHD) across the lifespan.
Method:
The population costs of ADHD in Australia were estimated for the financial year 2018 to 2019 using a prevalence approach to cost estimation across all ages. Financial (healthcare, productivity, education and justice systems, and deadweight losses) and non-financial costs were measured (Disability Adjusted Life Years (DALYs)).
Results:
The total social and economic cost of ADHD in 2018 to 2019 were US$12.76 billion (range US$8.40 billion to US$17.44 billion, with per person costs of US$15,664 per year). Productivity costs made up 81% of the total financial costs, followed by deadweight losses (11%), and health system costs (4%). Loss in terms of wellbeing was significant (US$5.31 billion).
Conclusion:
There is a need to raise public awareness of the considerable socioeconomic impact and burden of ADHD in order to drive investment and policy decisions that improve identification and treatment of ADHD.
AdvokatC. (2010). What are the cognitive effects of stimulant medications? Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD). Neuroscience & Biobehavioral Reviews, 34(8), 1256–1266.
AppletonR.ConnellC.FaircloughE.TuomainenH.SinghS. P. (2019). Outcomes of young people who reach the transition boundary of child and adolescent mental health services: A systematic review. European Child & Adolescent Psychiatry, 28(11), 1431–1446.
4.
Australian Bureau of Statistics. (2018a). Average Weekly Earnings, Australia, May 2018, 6302.0.
5.
Australian Bureau of Statistics. (2018b). Labour Force, Australia, Detailed, Quarterly, Aug 2018, 6291.0.55.003.
6.
Australian Bureau of Statistics. (2019a). Recorded crime – offenders, 2017-18, cat. no. 4519.0.
Australian Taxation Office. (2016). Annual report 2015-16. Canberra, Australia: Australian Taxation Office\.
9.
BonviciniC.FaraoneS. V.ScassellatiC. (2016). Attention-deficit hyperactivity disorder in adults: A systematic review and meta-analysis of genetic, pharmacogenetic and biochemical studies. Molecular Psychiatry, 21(7), 872–884. https://doi.org/10.1038/mp.2016.74
10.
BrittH.MillerG. C.HendersonJ.BayramC.HarrisonC.ValentiL.WongC.GordonJ.PollackA. J.PanY.CharlesJ. (2016). General practice activity in Australia 2015–16. General practice series no. 40. Sydney University Press.
11.
CaoL.HoskingA.KouparitsasM.MullalyD.RimmerX.ShiQ.StarkW.WendeS. (2015). Understanding the economy-wide efficiency and incidence of major Australian taxes. Treasury Working Paper. Australia: Australian Government, The Treasury.
12.
CapusanA. J.BendtsenP.MarteinsdottirI.LarssonH. (2019). Comorbidity of adult ADHD and its subtypes with substance use disorder in a large population-based epidemiological study. Journal of Attention Disorders, 23(12), 1416–1426. https://doi.org/10.1177/1087054715626511
13.
CayeA.SwansonJ. M.CoghillD.RohdeL. A. (2019). Treatment strategies for ADHD: An evidence-based guide to select optimal treatment. Molecular Psychiatry, 24(3), 390–408.
14.
ChanE.ZhanC.HomerC. J. (2002). Health care use and costs for children with attention-deficit/hyperactivity disorder. Archives of Pediatrics and Adolescent Medicine, 156(5), 504–511.
15.
ChenQ.HartmanC. A.HaavikJ.HarroJ.KlungsoyrK.HegvikT.-A.WandersR.OttosenC.DalsgaardS.FaraoneS. V.LarssonH. (2018). Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: A population-based cross-sectional study. PLoS One, 13(9), e0204516. https://doi.org/10.1371/journal.pone.0204516
16.
CoghillD. (2019). Debate: Are stimulant medications for attention-deficit/hyperactivity disorder effective in the long term? (for). Journal of the American Academy of Child and Adolescent Psychiatry, 58(10), 938–939.
17.
D’AmicoF.KnappM.BeechamJ.SandbergS.TaylorE.SayalK. (2014). Use of services and associated costs for young adults with childhood hyperactivity/conduct problems: 20-year follow-up. The British Journal of Psychiatry, 204(6), 441–447. https://doi.org/10.1192/bjp.bp.113.131367
18.
DaleyD.JacobsenR. H.LangeA. M.SorensenA.WalldorfJ. (2019). The economic burden of adult attention deficit hyperactivity disorder: A sibling comparison cost analysis. European Psychiatry, 61, 41–48. https://doi.org/10.1016/j.eurpsy.2019.06.011
19.
DalsgaardS.OstergaardS. D.LeckmanJ. F.MortensenP. B.PedersenM. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: A nationwide cohort study. Lancet, 385(9983), 2190–2196. http://doi.org/10.1016/s0140-6736(14)61684-6
20.
Deloitte Access Economics. (2015). The hidden costs of asthma. Canberra, Australia: Deloitte Access Economics.
DoshiJ. A.HodgkinsP.KahleJ.SikiricaV.CangelosiM. J.SetyawanJ.ErderM. HNeumannP. J. (2012). Economic impact of childhood and adult aitention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 990–1002. https://doi.org/10.1016/j.jaac.2012.07.008
23.
EbejerJ. L.MedlandS. E.van der WerfJ.GondroC.HendersA. K.LynskeyM.MartinN. G.DuffyD. L. (2012). Attention deficit hyperactivity disorder in Australian adults: Prevalence, persistence, conduct problems and disadvantage. PLoS One, 7(10), e47404. https://doi.org/10.1371/journal.pone.0047404
24.
EfronD.MoisucO.McKenzieV.SciberrasE. (2016). Service use in children aged 6–8 years with attention deficit hyperactivity disorder. Archives of Disease in Childhood, 101(2), 161–165. http://doi.org/10.1136/archdischild-2015-309520
25.
EkeH.FordT.Newlove-DelgadoT.PriceA.YoungS.AniC.SayalK.LynnR. M.JansennsA. (2019). Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): Findings from a British national surveillance study. The British Journal of Psychiatry. 1–7. http://doi.org/10.1192/bjp.2019.131
26.
ErskineH. E.FerrariA. J.PolanczykG. V.MoffittT. E.MurrayC. J. L.VosT.WhitefordH. A.ScottJ. G. (2014). The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. Journal of Child Psychology and Psychiatry, 55(4), 328–336. https://doi.org/10.1111/jcpp.12186
27.
ErskineH. E.NormanR. E.FerrariA. J.ChanG. C.CopelandW. E.WhitefordH. A.ScottJ. G. (2016). Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 55(10), 841–850.
FletcherJ. M. (2014). The effects of childhood ADHD on adult labor market outcomes. Health Economics, 23(2), 159–181.
31.
FloodE.GajriaK.SikiricaV.DietrichC. N.RomeroB.HarpinV.BanaschewskiT.QuinteroJ.ErderM. H.FridmanM.ChenK. T. J. o. a. d. (2016). The Caregiver Perspective on Paediatric ADHD (CAPPA) survey: Understanding sociodemographic and clinical characteristics, treatment use and impact of ADHD in Europe. Journal of Affective Disorders, 200, 222–234.
32.
FordT. (2020). Transitional care for young adults with ADHD: Transforming potential upheaval into smooth progression. Epidemiology and Psychiatric Sciences, 29, e87.
33.
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392(10159), 1789–1858.
34.
Gupte-SinghK.SinghR. R.LawsonK. A. (2017). Economic burden of attention-deficit/hyperactivity disorder among pediatric patients in the United States. Value Health, 20(4), 602–609. https://doi.org/10.1016/j.jval.2017.01.007
35.
HoldenS. E.Jenkins-JonesS.PooleC. D.MorganC. L.CoghillD.CurrieC. J. (2013). The prevalence and incidence, resource use and financial costs of treating people with attention deficit/hyperactivity disorder (ADHD) in the United Kingdom (1998 to 2010). Child and Adolescent Psychiatry and Mental Health, 7(1), 34.
36.
HollisC. (2018). ADHD and transitions to adult mental health services. In BanaschewskiT.CoghillD.AlessandroZ. (Eds.), Oxford textbook of attention deficit hyperactivity disorder. Oxford University Press.
37.
HongM.ParkB.LeeS. M.BahnG. H.KimM. J.ParkS.OhI. H.ParkH. (2019). Economic burden and Disability-Adjusted Life Years (DALYs) of attention deficit/hyperactivity disorder. Journal of Attention Disorders, 24(6), 823–829. https://doi.org/10.1177/1087054719864632
JohnsonS. E.LawrenceD.HafekostJ.SawS.BuckinghamW. J.SawyerM.AinleyJ.ZubrickS. R. (2016). Service use by Australian children for emotional and behavioural problems: Findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry, 50(9), 887–898.
40.
KesslerR. C.AdlerL.AmesM.BarkleyR. A.BirnbaumH.GreenbergP.JohnstonJ. A.SpencerT.ÜstünT. B. (2005). The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. Journal of Occupational and Environmental Medicine, 47(6), 565–572.
41.
KPMG Econtech. (2010). CGE analysis of the current Australian tax system (Report for the Australian Government the Treasury, March, Canberra). Australia: KPMG.
42.
LangbergJ. M.BeckerS. P. (2012). Does long-term medication use improve the academic outcomes of youth with attention-deficit/hyperactivity disorder?Clinical Child and Family Psychology Review, 15(3), 215–233. http://doi.org/10.1007/s10567-012-0117-8
43.
LarsonK.RussS. A.KahnR. S.HalfonN. (2011). Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics, 127(3), 462–470.
44.
LawrenceD.JohnsonS.HafekostJ.BoterhovendeHaanK.SawyerM.AinleyJ.ZubrickS. R. (2015). The mental health of children and adolescents (Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing). Canberra, Australia: Department of Health.
45.
LeH. H.HodgkinsP.PostmaM. J.KahleJ.SikiricaV.SetyawanJ.ErderM. H.DoshiJ. A. (2014). Economic impact of childhood/adolescent ADHD in a European setting: The Netherlands as a reference case. European Child and Adolescent Psychiatry, 23(7), 587–598. https://doi.org/10.1007/s00787-013-0477-8
46.
MatteB.AnselmiL.SalumG. A.KielingC.GonçalvesH.MenezesA.GrevetE. H.RohdeL. A. (2015). ADHD in DSM-5: A field trial in a large, representative sample of 18- to 19-year-old adults. Psychological Medicine, 45(2), 361–373.
47.
MatzaL. S.ParamoreC.PrasadM. (2005). A review of the economic burden of ADHD. Cost Effectiveness and Resource Allocation, 3(1), 5. https://doi.org/10.1186/1478-7547-3-5
MorganA. (2018). How much does prison really cost? Comparing the costs of imprisonment with community corrections (Research Reports no. 5). Canberra, Australia: Australian Institute of Criminology.
PelhamW. E.FosterE. M.RobbJ. A. (2007). The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. Journal of Pediatric Psychology, 32(6), 711–727.
PolanczykG.de LimaM. S.HortaB. L.BiedermanJ.RohdeL. A. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. American Journal of Psychiatry, 164(6), 942–948
55.
QuinteroJ.Ramos-QuirogaJ. A.San SebastianJ.MontanesF.Fernandez-JaenA.Martinez-RagaJ.GiralM. G.GraellM.MardomingoM. J.SoutulloC.AldaJ. A. (2018). Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: A descriptive analysis. BMC Psychiatry, 18(1), 1–10. https://doi.org/10.1186/s12888-017-1581-y
56.
Risk Solutions. (2011). The costs to Britain of workplace injuries and work-related ill health in 2006/07: Workplace fatalities and self reports (Report prepared for the Health and Safety Executive). England: Health and Safety Executive. http://www.hse.gov.uk/research/rrpdf/rr897.pdf.
57.
Safe Work Australia. (2015). The cost of work-related injury and illness for Australian employers, workers and the community 2012–13. Canberra, Australia: Safe Work Australia.
58.
SchlanderM.TrottG. E.SchwarzO. (2010). The health economics of attention deficit hyperactivity disorder in Germany - Part 1: Health care utilization and cost of illness. Der Nervenarzt, 81(3), 289–300. https://doi.org/10.1007/s00115-009-2888-9
59.
SciberrasE.LucasN.EfronD.GoldL.HiscockH.NicholsonJ. M. (2017). Health care costs associated with parent-reported ADHD: A longitudinal Australian population-based study. J Atten Disord, 21(13), 1063–1072. https://doi.org/10.1177/1087054713491494
60.
SciberrasE.LycettK.EfronD.MensahF.GernerB.HiscockH. (2014). Anxiety in children with attention-deficit/hyperactivity disorder. Pediatrics, 133(5), 801–808.
61.
SecnikK.SwensenA.LageM. J. (2005). Comorbidities and costs of adult patients diagnosed with attention-deficit hyperactivity disorder. Pharmacoeconomics, 23(1), 93–102.
62.
ShawM.HodgkinsP.CaciH.YoungS.KahleJ.WoodsA. G.ArnoldL. E. (2012). A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: Effects of treatment and non-treatment. BMC Medicine, 10(1), 99. https://doi.org/10.1186/1741-7015-10-99
63.
SmithR.JornaP.SweeneyJ.FullerG. (2015). Counting the costs of crime in Australia. Canberra, Australia: Australian Institute of Criminology.
64.
StorebøO. J.KroghH. B.RamstadE.Moreira-MaiaC. R.HolmskovM.SkoogM.NilausenT. D.MagnussonF. L.ZwiM.GilliesD.RosendalS.GluudC. (2015). Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents: Cochrane systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. BMJ, 351, h5203. https://doi.org/10.1136/bmj.h5203
65.
Vande VoortJ. L.HeJ.JamesonN. D.MerikangasK. R. (2014). Impact of the DSM-5 attention-deficit/hyperactivity disorder age-of-onset criterion in the US adolescent population. Journal of the American Academy of Child & Adolescent Psychiatry, 53(7), 736–744.
66.
WilloughbyM. T. (2003). Developmental course of ADHD symptomatology during the transition from childhood to adolescence: A review with recommendations. Journal of Child Psychology and Psychiatry, 44(1), 88–106.
67.
ZendarskiN.SciberrasE.MensahF.HiscockH. (2018). Factors associated with educational support in young adolescents with ADHD. Journal of Attention Disorders, 24(5), 75–757.
68.
ZhaoX.PageT. F.AltszulerA. R.PelhamW. E.IIIKippH.GnagyE. M.CoxeS.SchatzN. K.MerrillB. M.MacpheeF. L.PelhamW. E.Jr. (2019). Family burden of raising a child with ADHD. Journal of Abnormal Child Psychology, 47(8), 1327–1338. https://doi.org/10.1007/s10802-019-00518-5
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