Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Feb 8;18(1):40.
doi: 10.1186/s12888-017-1581-y.

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis

Javier Quintero  1 , Josep A Ramos-Quiroga  2 , Javier San Sebastián  3 , Francisco Montañés  4 , Alberto Fernández-Jaén  5 , José Martínez-Raga  6 , Marta García Giral  7 , Montserrat Graell  8 , María J Mardomingo  9 , César Soutullo  10 , Jesús Eiris  11 , Montserrat Téllez  12 , Montserrat Pamias  13 , Javier Correas  14 , Juncal Sabaté  15 , Laura García-Orti  15 , José A Alda  16
Affiliations
Multicenter Study

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis

Javier Quintero et al. BMC Psychiatry. .

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in childhood (5.3% to 7.1% worldwide prevalence), with substantial overall financial burden to children/adolescents, their families, and society. The aims of this study were to describe the clinical characteristics of children and adolescents with ADHD in Spain, estimate the associated direct/indirect costs of the disorder, and assess whether the characteristics and financial costs differed between children/adolescents adequately responding to currently available pharmacotherapies compared with children/adolescents for whom pharmacotherapies failed.

Methods: This was a multicenter, cross-sectional, descriptive analysis conducted in 15 health units representative of the overall Spanish population. Data on demographic characteristics, socio-occupational status, social relationships, clinical variables of the disease, and pharmacological and non-pharmacological treatments received were collected in 321 children and adolescents with ADHD. Direct and indirect costs were estimated over one year from both a health care system and a societal perspective.

Results: The estimated average cost of ADHD per year per child/adolescent was €5733 in 2012 prices; direct costs accounted for 60.2% of the total costs (€3450). Support from a psychologist/educational psychologist represented 45.2% of direct costs and 27.2% of total costs. Pharmacotherapy accounted for 25.8% of direct costs and 15.5% of total costs. Among indirect costs (€2283), 65.2% was due to caregiver expenses. The total annual costs were significantly higher for children/adolescents who responded poorly to pharmacological treatment (€7654 versus €5517; P = 0.024), the difference being mainly due to significantly higher direct costs, particularly with larger expenses for non-pharmacological treatment (P = 0.012).

Conclusions: ADHD has a significant personal, familial, and financial impact on the Spanish health system and society. Successful pharmacological intervention was associated with lower overall expenses in the management of the disorder.

Keywords: ADHD; Adolescence; Economic evaluation; School children.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The central Ethics Committee that approved the study was the Niño Jesús Hospital Committee (Madrid), and all children/adolescents and their legal representatives signed a written informed consent form prior to participation in the study.

Consent for publication

Not applicable.

Competing interests

JQ: participated as speaker and/or acted as consultant for Grunenthal, Lilly, Shire, MSD, Janssen & Ferrer; received unrestricted educational and research support from Mutua Madrileña and Otsuka. JAR-Q: on the speakers bureau and/or acted as consultant for Eli Lilly, Novartis, Shire, Lundbeck, Ferrer, Medice, and Rubió; received travel awards from Rubió, Ferrer, Shire, and Eli Lilly; received unrestricted educational and research support from Eli Lilly, Shire, Rovi, Ferrer, Lundbeck, and Rubió. FM: received funding for collaborations for congress organization from Shire, Rubió, and Rovi. AF-J: received economic support to attend courses/congresses from Janssen, Eli Lilly, Rubio, Juste, Shire, and Otsuka; received fees for participation in medical congresses from Janssen, Eli Lilly, Rubio, Juste, and Shire; participated in advisory boards for Janssen, Eli Lilly, and Shire; received grants from Janssen, Eli Lilly, Rubio, and Shire. JM-R: received honoraria for being a speaker and acting on advisory boards from Shire and Janssen Pharmaceuticals. CS: received non-personal research funds for his department from Caja Navarra Foundation, Lundbeck, Shire, and Teva; served as consultant for Alicia Koplowitz Foundation, Editorial Médica Panamericana, Eli Lilly, EUNETHYDIS, Instituto de Salud Carlos III, Medice/Juste, NeuroTech Solutions Ltd., Rubió, and Shire; served on speakers bureaux on continuous medical education for Eli Lilly, Shire, Universidad Internacional Menéndez Pelayo, and Universidad Internacional de La Rioja (UNIR); received royalties from DOYMA, Editorial Médica Panamericana, and Mayo Ediciones. MT: received grant/research support from Shire Pharmaceuticals S.L., Rubio, Rovi, and Janssen. MP: participated as speaker for Lilly, Shire, and Rovi. JC: received consulting income and research support from Janssen, Shire, Ferrer, Lilly, and Lundbeck. JS and LG-O are employees of Shire. JSS, MGG, MG, MJM, and JE received support from Shire for this research. JAA: acted as consultant to or received honoraria or grants from Eli Lilly, Shire, Janssen Cilag, Rovi, Spanish Ministry of Health, Instituto de Salud Carlos III, Agència d’Informació, Avaluació i Qualitat en Salut (AIAQS), and the Alicia Koplowitz Foundation.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
National ADHD-related costs by cost categories
Fig. 2
Fig. 2
ADHD costs (€) in children/adolescents with adequate pharmacological treatment response versus those for whom treatment failed
See this image and copyright information in PMC

References

    1. Flood E, Gajria K, Sikirica V, Dietrich CN, Romero B, Harpin V, et al. The Caregiver Perspective of Paediatric ADHD (CAPPA) survey: understanding sociodemographic and clinical characteristics, treatment use, and impact of ADHD in Europe. J Affect Disord. 2016;200:222–34. - PubMed
    1. Polanczyk G, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol. 2014;43:434–42. - PMC - PubMed
    1. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012;9:490–499. doi: 10.1007/s13311-012-0135-8. - DOI - PMC - PubMed
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) Arlington, VA: American Psychiatric Publishing; 2013.
    1. Hodgkins P, Setyawan J, Mitra D, Davis K, Quintero J, Fridman M, et al. Management of ADHD in children across Europe: patient demographics, physician characteristics, and treatment patterns. Eur J Pediatr. 2013;172:895–906. doi: 10.1007/s00431-013-1969-8. - DOI - PMC - PubMed

Publication types

LinkOut - more resources