The treatment costs of ADHD - A framework for future economic evaluations

Abstract: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurobehavioral problems among both children and adults. Around 5% of the children and 3- 4% of the adults suffers from the condition in Sweden. In general, diagnosed children achieve poorer results on standardized tests, receive lower grades and are more prone to dropout of school. Adults tend to struggle with work-performance, have lower socioeconomic status, and also finding it tougher with handling social bonds. Occasionally psychological intervention is enough for treating the condition; nevertheless, in general there is an additional need of pharmacological treatment. The ADHD-related drug use and ADHD-prevalence has increased considerably since the year 2006 in Sweden, yet no study fully investigating the associated costs has so far been conducted. In consideration to this, the aim of this thesis is to investigate the direct costs related to ADHD in Sweden. The results can be of assistance when performing economic evaluations of the costs and benefits of treating ADHD, as well as when performing health economic simulation modelling. These are some of the most common policy tools when it comes to determining the interventions regarding health policies. Longitudinal panel data between 2006-2013, based on four linked registers of the total Swedish population diagnosed with ADHD, is used in order to investigate the direct costs. The four registers enable us to investigate subgroups and cost patterns over time in a more comprehensive way than what have been possible in previous studies. The main results are that the predicted marginal cost for an individual diagnosed with ADHD is 11,344 SEK per year and drug costs followed by outpatient procedure costs are the largest cost drivers. Over a ten-year period, the costs peak at the first year of follow-up, i.e. the year of diagnosis, and thereafter decrease gradually. Furthermore, individuals diagnosed with regular ADHD, or more than one diagnoses, and individuals aged 40-59 years bear the highest costs. Finally, the predicted marginal cost of having a comorbidity related to ADHD is 1,771 SEK per individual and year. The results suggest that there are large costs associated with being diagnosed with ADHD, and that further research and policy interventions are important in order to increase efficiency.