Attention-Deficit/Hyperactivity Disorder: Increased Costs for Patients and Their Families ANDRINE R. SWENSEN, PH.D., HOWARD G. BIRNBAUM, PH.D., KRISTINA SECNIK, PH.D., MARYNA MARYNCHENKO, B.A., PAUL GREENBERG, M.S., AND AMI CLAXTON, PH.D. ABSTRACT Objective: To estimate the direct (medical and prescription drug) and indirect (work loss) costs of children treated for attention-deficit/hyperactivity disorder (ADHD) and their family members. Method: The data source was an adminis- trative database from a national, Fortune 100 manufacturer that included all medical, pharmaceutical, and disability claims for beneficiaries (n > 100,000). The analysis involved four samples. The ADHD patient sample included indi- viduals age 18 or younger with at least one ADHD claim during the study period (1996–1998). Resource utilization of ADHD patients was contrasted with a matched control sample of patients who did not have claims for ADHD. The ADHD and non-ADHD family samples included non-ADHD family members of ADHD patients and their matched controls. Results: The annual average expenditure (direct cost) per ADHD patient was $1,574, compared to $541 among matched controls. The annual average payment (direct plus indirect cost) per family member was $2,728 for non-ADHD family members of ADHD patients versus $1,440 for family members of matched controls. Both patient and family cost differences were significant at the 95% confidence level. Conclusions: ADHD imposes a significant financial burden regarding the cost of medical care and work loss for patients and family members. J. Am. Acad. Child Adolesc. Psychiatry, 2003;42(12):1415–1423. Key Words: attention-deficit/hyperactivity disorder, direct costs, indirect costs, family burden. Attention-deficit/hyperactivity disorder (ADHD) has important consequences to the sufferers, as well as their parents and siblings (Anderson and Werry, 1994; Na- tional Institutes of Health, Centers for Disease Control and Prevention, 1998). Depending on the restricted- ness of the ADHD definition, prevalence estimates range from 3% to 10% of school-age children, with rates that are two to nine times greater among boys than girls (American Academy of Child and Adolescent Psychiatry, 1997, 2000; American Academy of Pediat- rics, 2000; Rowland et al., 2002). Alternatively, an Agency for Healthcare Research and Quality report, using less restrictive measures (not considering aca- demic and behavioral functioning impairment as crite- ria), estimates a prevalence rate of 16% (Agency for Health Care Policy and Research, 1999). While behavioral components of ADHD for chil- dren are well documented, recent research has consid- ered the associated health outcomes. ADHD patients exhibit increased use of mental health services, social services, and special education services (Agency for Health Care Policy and Research, 1999; Hansen et al., 1999; Szatmari et al., 1989). Studies also document that affected individuals have more psychosocial co- morbidities, chronic health conditions, and adverse medical outcomes such as substance abuse, automobile collisions, poisoning, and fractures (Barkley et al., 1990, 1993, 1996; Hansen et al., 1999; Nada-Raja et al., 1997; Woodward et al., 2000). High rates of com- mon comorbidities among ADHD patients also sug- gest that affected individuals experience a high use of Accepted August 4, 2003. Drs. Swensen and Claxton were employed by Eli Lilly and Company (In- dianapolis) when the research was conceptualized and when the initial analysis was conducted. Dr. Swensen is currently under a consulting relationship with Eli Lilly. Dr. Birnbaum, Ms. Marynchenko, and Mr. Greenberg are employed by Analysis Group, Inc., Boston. Dr. Secnik is an employee of Eli Lilly and Company. Research supported by an unconditional grant from Eli Lilly and Company. Portions of this manuscript were presented at the 48th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, October 2001. Correspondence to Dr. Birnbaum, Analysis Group, Inc., 111 Huntington Avenue, 10th Floor, Boston, MA 02199; e-mail: hbirnbaum@analysisgroup. com. 0890-8567/03/4212–1415©2003 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/01.chi.0000093323.86599.44 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 42:12, DECEMBER 2003 1415