Economic Burden and Service Utilisation of Children with Attention-Deficit/Hyperactivity Disorder (ADHD) - A Systematic Review and Meta-Analysis

OBJECTIVES:

Attention-deficit/hyperactivity disorder (ADHD) is the most common pediatric neurodevelopmental disorders. While the long-term outcomes associated with ADHD (e.g., low academic performance, increased behavioural problems) has been well-documented, less research focused on the economic burden and service utilisation of ADHD.

This study aims to systematically synthesise the literature on service utilisation and the economic costs of ADHD in children.

METHODS:

The search was conducted via nine databases; Medline, The Cochrane Library, NHSEED, HTA, DARE, EconLit, Embase, PsycINFO, CINAHL. Two reviewers independently screened title and abstract, and full-texts. Peer-reviewed primary studies published in English from 2007 to 2022 were included. The NHLBI (National Heart, Lung and Blood Institute) tool was used to assess the quality of included papers. Costs were synthesised using a three-step method of standardisation, inflation and conversion. Meta-analysis was conducted using Meta-XL.

RESULTS:

Thirty-two out of 7759 studies were included in the review, all of which were graded as ‘good’ in quality. Service utilisation and costs highly varied among studies. Mental health and pharmaceuticals service utilisation drove the direct costs, but absenteeism and unemployment were the main indirect costs. Annual health system costs per patient were higher in children with ADHD (ranged from $535 to $18752) than children without ADHD ($265 to $5917). Children with ADHD were associated with higher societal costs (i.e. $1912 to $29676) compared to children in the general population (i.e. $384 to $10197). Meta-analysis revealed a large pooled effect size of ADHD direct medical costs (Hedges’ g 1.01) and high heterogeneity (I² =99.7%).

CONCLUSIONS:

ADHD was associated with increased service utilisation (mainly mental health and pharmaceutical services) and costs (both direct and indirect). Given the substantial economic burden of ADHD, strategies to improve service utilisation for children with ADHD to mitigate the economic burden of ADHD would be needed.