weiss the economic costs of adhd

8/17/2019 Weiss the Economic Costs of ADHD

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The Economic Costs of ADHDMargaret Weiss MD, PhDMargaret Weiss MD, PhD

Head, Provincial ADHD ProgramHead, Provincial ADHD Program

British ColumbiaBritish Columbia

CADDRA EecutiveCADDRA Eecutive

Clinical Professor, !BCClinical Professor, !BC

The Economic Costs of ADHD


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ADHD at a glance ADHD at a glance

" Affects # $ %& of school$aged children, Affects # $ %& of school$aged children,''

(ith bo)s three times more li*el)(ith bo)s three times more li*el)to have it than girlsto have it than girls++

" nheritable conditionnheritable condition

#- . /-& chance that a brother or sister (ill have ADHD#- . /-& chance that a brother or sister (ill have ADHD##

More than half of all 0arents (ith ADHD (ill have a child (ith ADHDMore than half of all 0arents (ith ADHD (ill have a child (ith ADHD//

" E0erts estimate that u0 to 1-& of children (ith the disorder carr)E0erts estimate that u0 to 1-& of children (ith the disorder carr)

their s)m0toms into adulthoodtheir s)m0toms into adulthood22

" Re0orted im0acts suggest that children (ith ADHD often have 0roblemsRe0orted im0acts suggest that children (ith ADHD often have 0roblems

in their ever)da) lives be)ond the core s)m0toms of the disorder itself in their ever)da) lives be)ond the core s)m0toms of the disorder itself 11

3o( self$esteem3o( self$esteem%%

Emotional and social 0roblemsEmotional and social 0roblems44

5re6uent underachievement at school5re6uent underachievement at school77

nabilit) to 0artici0ate in social echanges 8e9g9, sharing, coo0eration:nabilit) to 0artici0ate in social echanges 8e9g9, sharing, coo0eration:'-'-

1 DSM IV; 2,3 Faraone SV 2008; 4 Biederman 2003; 5 Weiss G 1993; 6 Eso!ar 2005", 8, 9, #I$E 2006; 10 Bar%&e' () 2002


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ADHD; A Public Health


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World(ide Prevalence in =chool AgeChildren

0% 5% 10%

DSM-IV

DSM-III-R

DSM-III

ICD-9

+riteria

#realen&eFaraone, 2004, World Psychiatry

World(ide Prevalence in =chool Age

Children

Alemania, 1990

'relanda 1991

#$erto %i&o, 1988

Nueva !elanda, 198"

ntario, 1989

Reino Unido, 1991

Suiza, 1998

España, 1995

USA, 1996

Brasil, 1999

Holanda, 2000

Lugar , Año


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Prevalence of Adult ADHDPrevalence of Adult ADHD

Goldman et al.Goldman et al. JAMA. JAMA. 1998;279:1100-1107. Barkley RA. Attention-deficit hyperactiity1998;279:1100-1107. Barkley RA. Attention-deficit hyperactiitydi!order. "n: #a!h $%& Barkley RA& ed!.di!order. "n: #a!h $%& Barkley RA& ed!. Child Psychopathology Child Psychopathology . 199':'(-112.. 199':'(-112.

) ( - 7* of !chool-a+ed children- 7* of !chool-a+ed children) '0* contin,e to hae'0* contin,e to haeimpairmentimpairment

into ad,lthoodinto ad,lthood

) herefore 2 /.2* prealence herefore 2 /.2* prealencein ad,lt!in ad,lt!

#,rphy and Barkley 199'a#,rphy and Barkley 199'a /.7*/.7*

#,rphy and Barkley 199'#,rphy and Barkley 199' /.7*/.7*

,a,l& 3eyandt et. al. 1997,a,l& 3eyandt et. al. 1997 /.4*/.4*

5eili+en!tein et. al. 19975eili+en!tein et. al. 1997 /.0*/.0*

ult ADHD Epidemiology Studiesult ADHD

Epidemiology Studies

hildhood Epidemiology

Most quotedMost quotedadultadultprevalenceprevalencerate is 4% (7rate is 4% (7million adultsmillion adults

NA-'NA.+/%B''-*SU%* %'SKessler, et al3

hildhood

Epidemiology


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Persistance

Biederman 1996

.ar 1995

7ord 1992

$ane&& 1989

Mann::a 1993

Mann::a 1991

Mann::a 1991

Gi&eman 1985

Mann::a ; Gi&eman 1984


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Age$s0ecific Prevalence of ADHD Age$s0ecific Prevalence of ADHD

Remission;Remission; D=M$$RD=M$$R ADHD ADHD* *


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Meth)l0henidate and Am0hetaminePrescri0tions

02000

7000

6000

8000

10000

12000

17000

16000

18000

1991 1992 199 1997 1995 1996 199"

/eth)lphenidate Amphetamine -otal

Sore= IMS .ea&-, #aiona& resri>ion )di &s ?M

N u

m b e r o f P r e s c r

i p t i o n s ( 0 0 0 ’ s


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Average !revalence o" ADHDAverage !revalence o" ADHD Comor#idityComor#idity

Barkley et al.& 199'a; Beidermanet al.& 199(; #,rphy 6 Barkley& 199'; Roy-Byrne et al.& 1997; hekimet al.& 1990

Comor#idityComor#idity Est$ !revalenceEst$ !revalence)Mood Disorder &% ' (7%

)An)iety Disorder *+% ' +,%

)Alcohol A#use (*% ' +(%)-ther Su#stance A#use .% ' (*%

)!ersonality Disorder ,% '*,%

)Antisocial /ehavior .% ' *.%


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Domains of m0airmentDomains of m0airment

'mpairments'mpairments

A&ademi&>

&&$pational

:ealth>'n?$r)S$@stan&e Use

isorders 4SUs

Se$alBehaior

+riminalit)So&ial

;$n&tioning

Selesteem

riing

#arenting


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m0act of !ntreated and !nder$m0act of !ntreated and !nder$

treated ADHDtreated ADHD

#atient;amil)

=5C #arental ior&e

or Separation11,12

2=7C Si@ling ;ights1

So&iet) S$@stan&e Use isordersD

2C %isE8

arlier nset9.ess .iEel) to F$it

in Ad$lthood10

S&hool G &&$pation

76 pelled6

5 rop $t6

.ower &&$pational Stat$s"

:ealth +areS)stem

50 in @iEe a&&idents1

in % isits2

2=7C more motor

ehi&le &rashes5

mplo)er

#arentalA@senteeism17

and

#rod$&tiit)17

1+ DiSa&a e a&+ 1998

2+


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ADHD; =ocial, Emotional, and ADHD; =ocial, Emotional, and

Cognitive Conse6uencesCognitive Conse6uences

, ,% *,% ,% 4,% +,% 0,%

Attempt SuicideAttempt Suicide1ired "rom 2o#1ired "rom 2o#

3ncarcerated3ncarcerated

3ntentional 3nury3ntentional 3nury

Su#stance A#useSu#stance A#use

e)ually 5ransmitted Diseases)ually 5ransmitted Diseases

5een !regnancy5een !regnancy

6epeat a rade6epeat a rade

/ar9ley 6A$ Attention-Deficit Hyperactivity Disorder: AHandbook for Diagnosis and Treatment : &&.$

% o" -ccurrence

TDAH

8ormal


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m0act of !ntreated ADHD onm0act of !ntreated ADHD on Academic Performance Academic Performance

en!en& A et al. ,licationen!en& A et al. ,licationendin+endin+

,

,

*,

,

4,

+,

E)pelledE)pelled6etained6etainedin gradein gradeat leastat least

onceonce

SuspendedSuspendedat leastat least

onceonce

Did notDid notcomplete highcomplete high

schoolschool

!erce!erce

ntnt

More than = #illion in annual pu#lic schoolMore than = #illion in annual pu#lic schoole)penditurese)penditures


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Driving$related oung Adults

0 20 70 60 80 100

/$ltiple motor

ehi&le &rashes

At a$lt or &rash

+itations or trai& iolations

Nonmedi&ated A: 4nH5 +ontrol 4nH6

P


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0 2 7 6 8

ADHD Adolescents and Driving ADHD Adolescents and Driving

Bar%&e' (), e a&+ Pediatrics. 1993;92=212@218; $oA D, e a&+ J Nerv Ment Dis. 2000;188;230@234+

Bar%&e' (), e a&+ Pediatrics. 1996;98=1089@1095; Mr>-' , Bar%&e' ()+ om! Psychiatry. 1996;3"=393@401+

'n&reased liEelihood o o$t&ome &ompared withagemat&hed &ontrols

ehi&le a&&ident

'n&$r asso&iatedin?$ries

At a$lt

/ore iolations

/ore speedingiolations

.i&enses$spended

/ore damage >in?$ries

15


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Driving m0airments inDriving m0airments in

Adults (ith ADHD Adults (ith ADHD

P C0+01+

0

1

2

7

5

6

-otal -i&Eets Speeding

-i&Eets

S$spensions /A

A: 4NH105+ontrol 4NH67*

* *

De>armen o Moor Ve-i&e Daa

Bar%&e' e a&+ J "nt Neuro!sychol Soc + 2002;8=655+


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Driving Performance inDriving Performance in

Adolescents (ith ADHD Adolescents (ith ADHD" Randomi?ed, crossover, single$blind stud)Randomi?ed, crossover, single$blind stud)

" 1 male drivers (ith ADHD aged '11 male drivers (ith ADHD aged '1 . .'7 )ears'7 )ears

" Com0arison of e6ual doses of


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Medical Costs in Children andMedical Costs in Children and

Adolescents (ith ADHD Adolescents (ith ADHD

0 20 70 60 80 100

/a?or in?$ries

'npatient admission

$tpatient admission

admission

A: 4NH09 +ontrol 4NH810


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ADHD; Cost of Medical Care

A:A:NonA:NonA:I0

I1000

I2000

I000

I7000

I5000

198" S198" S

Do&&arsDo&&ars

I1977I1977

I706JI706J

P P C+01 s non@)D.D er >erson


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I0

I2,000

I7,000

I6,000

I8,000

I10,000

+ontrol #atients A: #atients +ontrol mplo)ees A: mplo)ees

ther

%

#roiders i&e

:ospital 'npatient

#res&ription r$g

:ospital $tpatient

LorE A@sen&e

Ann$alAerage

#a)ments#er

#erson

1998 Average Costs per Patient and perEmployee by Medical and Prescription Drug

Claims and Work Loss

I"0I"0

I2,1"2I2,1"2

I,77I,77

I8,8I8,8

#atients mplo)ees

Sensen e a&Sensen e a&++


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ADHD and Economic Burden ADHD and Economic Burden

Sensen e a&Sensen e a&

500

0

1000

1500

2000

2500

3000

+ontrol;amilies

A:;amilies

All ;amil)/em@ers in

+ontrol;amil)

NonA:;amil)

/em@ers oA:

#atients

+ontrol;amilies

NonA:Si@lings o

A:#atients

1 9 8 " U S 0 o l l a r s

I1,220I1,220

I2,761I2,761

I1,70"I1,70"

I2,518I2,518

I7"I7"

I825I825

)&& Fami&' )&& Fami&'Mem!ersMem!ers

#on@)D.D#on@)D.DFami&' Mem!ersFami&' Mem!ers

#on@)D.D#on@)D.DSi!&insSi!&ins


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=eual Behavior=eual Behavior

" 3ongitudinal follo($u0 at )oung adulthood of a cohort of3ongitudinal follo($u0 at )oung adulthood of a cohort of

children 8ongoing Mil(au*ee follo($u0 stud): (ith ADHDchildren 8ongoing Mil(au*ee follo($u0 stud): (ith ADHD

com0ared (ith controlscom0ared (ith controls

=eual intercourse at earlier age 8'2 vs '1 )ears:=eual intercourse at earlier age 8'2 vs '1 )ears:

More seual 0artners 8'7 vs %:More seual 0artners 8'7 vs %:

More 0regnancies 8#4& vs /&:More 0regnancies 8#4& vs /&:

More seuall) transmitted diseases 8'%& vs /&:More seuall) transmitted diseases 8'%& vs /&:

Tested for H 82/& vs +'&:Tested for H 82/& vs +'&:

Bar%&e'+ ADHD# A Hand$oo% for Dia&nosis and 'reatment. #e or%= Gi&ord ress;1998=209+


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Biederman e a&+ Pediatrics 1999;104=e20+

=!Ds in Adolescents (ith ADHD=!Ds in Adolescents (ith ADHD

0

20

70

60

80

100

, e

r a l l % a t e o B S U 0 s 4 5 6 P


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ADHD and =mo*ing in Adults ADHD and =mo*ing in Adults

omer&ea e a&+ J Su$st A$use. 1995;"=3"3+

0 10 20 0 70 50 60

/en

Lomen

F$it %atio

Ad$lts with A: 4NH"1 (eneral #op$lation

+ $ r r e n t S m o E e r s

+ $ r r e n t S m o E e r s


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=!D Meta$anal)sis=!D Meta$anal)sis

Pooled Estimate of


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Public Health m0licationsPublic Health m0lications

Wi&ens e a&+ Pediatrics. 2003;111=1"9+

:igh prealen&e o A: in )o$ths:igh prealen&e o A: in )o$ths

:igh risE o )o$ths with A::igh risE o )o$ths with A:deeloping SUdeeloping SU

'dentii&ation and treatment o )o$ths with'dentii&ation and treatment o )o$ths withA: ma) ae&t a large segment o theA: ma) ae&t a large segment o the

adoles&ent and )o$ng ad$lt pop$lations atadoles&ent and )o$ng ad$lt pop$lations at

risE or SU3risE or SU3


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Criminalit) and ADHDCriminalit) and ADHD

" Conduct disorder and resulting antisocial disordersConduct disorder and resulting antisocial disordersoccur more fre6uentl) in 0atients (ith ADHD thanoccur more fre6uentl) in 0atients (ith ADHD thancontrolscontrols Cou0led (ith an im0ulsive, high$ris* Cou0led (ith an im0ulsive, high$ris*

lifest)le increases ris* for legal 0roblemslifest)le increases ris* for legal 0roblems

" Patients (ith ADHD are more li*el) to bePatients (ith ADHD are more li*el) to be Arrested 8#7& vs +-&: Arrested 8#7& vs +-&:

Convicted 8+4& vs ''&:Convicted 8+4& vs ''&: ailed 87& vs '&:ailed 87& vs '&:

Biederman e a&+ Arch Gen Psychiatry. 1996;53=43"+Mann::a e a&+ Arch Gen Psychiatry. 1989=46=10"3+


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ADHD in Adult Prison nmates ADHD in Adult Prison nmates

E'esone and .oe&&+ Bull Am Acad Psychiatry (a). 1994;22=181+

A:'nmates

NonA:'nmates

"5

25


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PortraitPortrait

of theof the

carecaregivergiver

for anfor an ADHD ADHD

childchild


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))$)+ J Am Acad hild Adolesc Psychiatry. 199";36=85S@121S+

Bar%&e' ()+ J Am Acad hild Adolesc Psychiatry. 1991;30="52@"62+

ADHD; m0airments in ADHD; m0airments in

=ociali?ation=ociali?ation" Children are stigmati?ed b) their behaviorChildren are stigmati?ed b) their behavior

• Troublemakers (bad sports)

• Excessive talking

• Cannot sit still

• Unfocused, not responsive

• Impulsive aggression

" Adolescents continue to demonstrate social 0roblems Adolescents continue to demonstrate social 0roblems Poor 0artici0ation in grou0 activitiesPoor 0artici0ation in grou0 activities

5e( friends, limited o00ortunities5e( friends, limited o00ortunities

ulnerable to antisocial grou0s, drug abuse, 0eer 0ressure ulnerable to antisocial grou0s, drug abuse, 0eer 0ressure

30

bl l h


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s ADHD as ADHD a =erious=erious Public HealthPublic Health

ConcernConcern

#$@li& :ealth#$@li& :ealth

Signii&an&eSignii&an&e

#realen&e

-reatment

e&tieness

+hroni&it)

'mpairment


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Cost of llness; C


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Cost Adult ADHDCost Adult ADHD''

" =urve) of 2-- subects (ith ADHD com0ared (ith=urve) of 2-- subects (ith ADHD com0ared (ith

2-' matched controls2-' matched controls

" Annual != household income losses due to ADHD %% Annual != household income losses due to ADHD %%billion)earbillion)ear

" F4,7-- to F'2,/-- 0er )ear 0er householdF4,7-- to F'2,/-- 0er )ear 0er household

Biederman /, 2008


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Costs of Adult ADHDCosts of Adult ADHD

" 3ess than +2& receive treatment3ess than +2& receive treatment''

" Adults (ith ADHD incur high health care costs Adults (ith ADHD incur high health care costs++

" Adults (ith ADHD are at increased ris* of asthma, Adults (ith ADHD are at increased ris* of asthma,de0ression, aniet), bi0olar, 0ersonalit) disorder, drugde0ression, aniet), bi0olar, 0ersonalit) disorder, drugabuse, smo*ingabuse, smo*ing

" Even after controlling for these conditions, d0ibGe theEven after controlling for these conditions, d0ibGe therates of in0atient, out0atient, 0rescri0tion costsrates of in0atient, out0atient, 0rescri0tion costs

" Health care cost of adult ADHD F21-- vs F+%-- forHealth care cost of adult ADHD F21-- vs F+%-- forcontrolscontrols++

" 3oss of (or* 0roductivit)3oss of (or* 0roductivit)##

1 Faraone 2004; 2 Seni% 2005; 3 Sensen 2003


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Cost Adult ADHDCost Adult ADHD''

" Ecess 0er ca0ita health care and (or* loss age % toEcess 0er ca0ita health care and (or* loss age % to

// and famil) members// and famil) members

" Administrative claims data from a large com0an) Administrative claims data from a large com0an)

" Total ecess cost ADHD in +--- in the != F#'91Total ecess cost ADHD in +--- in the != F#'91

billionbillion 2& treatment of the condition2& treatment of the condition

#4& other health care costs#4& other health care costs

/2& increased health care costs of famil) members/2& increased health care costs of famil) members

'+& 0roductivit) losses of adult famil) members'+& 0roductivit) losses of adult famil) members

1 Birn!am 2005


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Com0arator CostsCom0arator Costs''

" ADHD in children; /+92 billion ADHD in children; /+92 billion

" De0ression; // billionDe0ression; // billion

" =ubstance abuse; '4- billion=ubstance abuse; '4- billion" B!TB!T

" ADHD increases ris* for these other diseases ADHD increases ris* for these other diseases

" Prevalence 2&Prevalence 2&" Adult im0act based on 0revalence of /9/& even Adult im0act based on 0revalence of /9/& even

greatergreater

e&-am W 200"


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Cost ADHD in ChildrenCost ADHD in Children''

" Annual cost ADHD in children F'/,1-- 0er individual Annual cost ADHD in children F'/,1-- 0er individual

in +--2 != Fin +--2 != F '4& health care'4& health care

#/& education#/& education

/4& crime and delin6uenc)/4& crime and delin6uenc)

" /+92 billion)ear/+92 billion)ear

" Com0arable to asthmaCom0arable to asthma++

" ncreased ris* ER visits, comorbidit), accidentsncreased ris* ER visits, comorbidit), accidents

1 e&-am W 200"; $-an 2002;


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Cost of Childhood ADHDCost of Childhood ADHD##

" '# studies, none Canadian'# studies, none Canadian

" Per unit cost medication has increasedPer unit cost medication has increased

" Prescribing has increased to include 0reschoolers, (omen,Prescribing has increased to include 0reschoolers, (omen,

attention 0roblems and adultsattention 0roblems and adults" Io info on costs of ne( vs9 old medications or their costIo info on costs of ne( vs9 old medications or their cost

effectivenesseffectiveness

" Mental health treatment F+1#1Mental health treatment F+1#1

" Annual 0er child cost F22'4 Annual 0er child cost F22'4

" Education F/7--Education F/7--

" Crime F%-/-Crime F%-/-

" Total F'/2%1Total F'/2%1

1 Geara 2 e&&e-er 3 e&-am 200"


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Costs not accounted forCosts not accounted for

" =mo*ing=mo*ing++

" Drug abuseDrug abuse##

" 5oster care5oster care

" 5etal alcohol and narcotic s)ndrome5etal alcohol and narcotic s)ndrome" ictims of crime ictims of crime

" ictims of drug accidents ictims of drug accidents

" nsurance ratesnsurance rates

" ncreased 0revalence and adult 0revalence /9/& (ith 7-&ncreased 0revalence and adult 0revalence /9/& (ith 7-&

comorbidit)comorbidit)//

" =uffering to the individual, siblings, families, other children and=uffering to the individual, siblings, families, other children andteachersteachers

" Decreased life e0ectanc)Decreased life e0ectanc)''

1 Bar%&e' ( 2 omer&ea 3 Wi&ens ? 4 ess&er (


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=ummar) of != Cost Data=ummar) of != Cost Data

" Diagnosis increased from '9/& 8'7%7: to 79+&Diagnosis increased from '9/& 8'7%7: to 79+&

8'771:8'771:''

"Total costs of adult ADHD #'91 billion )ear +--- !=FTotal costs of adult ADHD #'91 billion )ear +--- !=F++

" Total costs child ADHD /+92 billionTotal costs child ADHD /+92 billion

" 3oss of (or* 0roductivit) in adults F%% billion3oss of (or* 0roductivit) in adults F%% billion

" Total %/9' billionTotal %/9' billion

" Annual costs of ADHD children F'/,1-- Annual costs of ADHD children F'/,1--

" Total cost treatment '91 billion or 2&Total cost treatment '91 billion or 2&++

1+ e&&e-er, 2000; 2+ e&-am 200" 3 Birn!am, 2005 4 Biederman, 200"


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We do not *no(We do not *no(

" Current medication costs in CanadaCurrent medication costs in Canada

" Patterns of insurancePatterns of insurance

" Cost effectiveness of ne( medicationsCost effectiveness of ne( medications" Cost of not insuring ne( medications . /1 0rovincesCost of not insuring ne( medications . /1 0rovinces

cover ne( medicationscover ne( medications

" Mean cost of non medication treatment in 0ractice .Mean cost of non medication treatment in 0ractice .

MTA behavior thera0), 0arent training, summer cam0MTA behavior thera0), 0arent training, summer cam0

and school consultation F1744)earand school consultation F1744)ear


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Ecluded ndirect CostsEcluded ndirect Costs

" 5etal alcoholnarcotic s)ndrome5etal alcoholnarcotic s)ndrome

" 3ife e0ectanc)3ife e0ectanc)

" Damaged self conce0tDamaged self conce0t

" Burden to siblingsBurden to siblings

" 5oster care and ado0tion5oster care and ado0tion

" WelfareWelfare

" Child and s0ousal abuseChild and s0ousal abuse" Alcohol and drug abuse in 0arents Alcohol and drug abuse in 0arents

" Parental morbidit)Parental morbidit)


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=ummar)=ummar)

" Cost of ADHD to health care, education, (or*,Cost of ADHD to health care, education, (or*,

ustice, social (elfare s)stem and driving insurance ustice, social (elfare s)stem and driving insurance

are eorbitantare eorbitant

" Cost of medication treatment a00roimates F'+--,Cost of medication treatment a00roimates F'+--,

but (ith high rates of non$adherencebut (ith high rates of non$adherence

" Cost of 0s)chological treatment a00roimates F/-- $Cost of 0s)chological treatment a00roimates F/-- $

F'+-- in 0racticeF'+-- in 0ractice

" The o00ortunit) cost of non treatment greatl)The o00ortunit) cost of non treatment greatl)

eceeds the cost of treatmenteceeds the cost of treatment


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The economic 0roblemThe economic 0roblem

" Resources are scarce, (ants or demands are infiniteResources are scarce, (ants or demands are infinite

" ndividuals have to ma*e choices or trade$offsndividuals have to ma*e choices or trade$offs

" Consumers have a budget constraintConsumers have a budget constraint

budgetJdis0osable incomebudgetJdis0osable income balanced against 0rices and amount of goodsservicesbalanced against 0rices and amount of goodsservices

consumedconsumed

" Consumers have 0references . the) *no( (hat the)Consumers have 0references . the) *no( (hat the)

li*eli*e Preferences reflect (ell$being obtained through consum0tionPreferences reflect (ell$being obtained through consum0tion

Preferences are endo(ed K (ell behaved $ aioms of choicePreferences are endo(ed K (ell behaved $ aioms of choice

All choices are ris*) . e0ected utilit) theor) All choices are ris*) . e0ected utilit) theor)

Economics is the science ofEconomics is the science of

choicechoice


45/61

L L Allocation of funds and facilities are nearl) al(a)s Allocation of funds and facilities are nearl) al(a)s

based on the o0inion of consultants but, more andbased on the o0inion of consultants but, more and

more, re6uests for additional facilities (ill have to bemore, re6uests for additional facilities (ill have to be

based on detailed arguments (ith hard evidenceN asbased on detailed arguments (ith hard evidenceN as

to the gain to be e0ected from the 0atientNs angleto the gain to be e0ected from the 0atientNs angle

and the cost9 5e( could 0ossibl) obect to this9O and the cost9 5e( could 0ossibl) obect to this9O

Cochrane A39 Effectiveness and Efficienc); randomCochrane A39 Effectiveness and Efficienc); random

reflections on health services9 Iuffield Provincialreflections on health services9 Iuffield Provincial

Hos0itals Trust, 3ondon, '7%+9Hos0itals Trust, 3ondon, '7%+9


46/61

eneric ste0s economic evaluationeneric ste0s economic evaluation

8': Define stud) 6uestion and 0ers0ective8': Define stud) 6uestion and 0ers0ective Describe alternatives, determine stud) 0ers0ectiveDescribe alternatives, determine stud) 0ers0ective

8+: dentif), measure and value costs and benefits8+: dentif), measure and value costs and benefits Measure costs and benefits in 0h)sical units relevant forMeasure costs and benefits in 0h)sical units relevant for

stud) 0ers0ective, value costs and benefitsstud) 0ers0ective, value costs and benefits

8#: Anal)sis of costs and benefits8#: Anal)sis of costs and benefits Discounting, incremental 8additional: costs and benefits ofDiscounting, incremental 8additional: costs and benefits of

alternatives, sensitivit) anal)sis on *e) 0arametersalternatives, sensitivit) anal)sis on *e) 0arameters

8/: Decision rule8/: Decision rule ncremental Cost$Effectiveness Ratios 8CERs: e9g9 cost 0erncremental Cost$Effectiveness Ratios 8CERs: e9g9 cost 0er

3> or QA3> thresholds, other decision$ma*ing criteria3> or QA3> thresholds, other decision$ma*ing criteria


47/61

l d d f


48/61

Qualit) Adusted 3ife >earsQualit) Adusted 3ife >ears

8QA3>s:8QA3>s:

'9--

-9--

-92-

-9%2

-9+2

Dead

5ull Health

Poor Health

Q l d d f


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Qualit) Adusted 3ife >earsQualit) Adusted 3ife >ears

8QA3>s:8QA3>s:

Dial)sisDial)sis

Trans0lantTrans0lant

3ife >ears ainedJ 13ife >ears ainedJ 1

QA3>s ained J 494QA3>s ained J 494

-- '/'/ +-+-

3ife >ears3ife >ears

-94-94

-91-91

Q u a l i t ) o f 3 i f

e

Q u a l i t ) o f 3 i f

e


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Health Economics of ADHDHealth Economics of ADHD

" ADHD is severel) im0airing ADHD is severel) im0airing

" t endurest endures

" ADHD 0atients remain im0aired from infanc) to old ADHD 0atients remain im0aired from infanc) to oldageage

" QA3> (ill be ver) highQA3> (ill be ver) high

" Treatments are efficient, efficacious and effectiveTreatments are efficient, efficacious and effective

" CERQA3> in ADHD favours 0rovision of o0timalCERQA3> in ADHD favours 0rovision of o0timal

treatmenttreatment


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=te0s to Change=te0s to Change

" Recogni?e ADHD as common, im0airing, and treatable Recogni?e ADHD as common, im0airing, and treatable

" dentif) current services dentif) current services

" dentif) (here there are no services dentif) (here there are no services

There is not a single centre of ecellence for ADHD in adults in Canada There is not a single centre of ecellence for ADHD in adults in Canada

" Assign res0onsbilit) to care Assign res0onsbilit) to care

" Develo0 interministerial services Develo0 interministerial services

" Eam0le; Iational nstitute for Health and Clinical Ecellence hasEam0le; Iational nstitute for Health and Clinical Ecellence has

0roduced a 0ractice guideline (hich mandates centres of ecellence0roduced a 0ractice guideline (hich mandates centres of ecellence

for ADHD throughout the ! including adult ADHD for ADHD throughout the ! including adult ADHD


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Research


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MethodMethod

" +-- se6uentiall) identified clinic children (ith no+-- se6uentiall) identified clinic children (ith noeclusionar) criteria a0art from understandingeclusionar) criteria a0art from understandingEnglishEnglish

" Measures;Measures; Child Health llness Profile 86ualit) of life . satisfaction,Child Health llness Profile 86ualit) of life . satisfaction,

resiliance, achievement, comfort, ris* avoidance:resiliance, achievement, comfort, ris* avoidance:

Ada0tive Behavior Assessment =)stem Ada0tive Behavior Assessment =)stem''

Resource !tili?ation QuestionnaireResource !tili?ation Questionnaire

=trengths and Difficulties Questionnaire=trengths and Difficulties Questionnaire++

Pediatric Adverse Events Rating =calePediatric Adverse Events Rating =cale##

Diagnoses 8$=AD=:Diagnoses 8$=AD=:

1 Do'&e ) 199"; 2 Goodman ( +sdino+om 3 Mar- / +a>n+or

http://www.sdqinfo.com/http://www.sdqinfo.com/


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Anal)ses Anal)ses

" C!A of current medication treatment and 0atterns ofC!A of current medication treatment and 0atterns oftreatment, treatment duration and 0ersistencetreatment, treatment duration and 0ersistence

" Direct and indirect costs of ADHD itself grou0ed b)Direct and indirect costs of ADHD itself grou0ed b)

education, health, 0arental lost da)s of (or*, famil)education, health, 0arental lost da)s of (or*, famil)costs, da) care costs, tutorscosts, da) care costs, tutors

" Ada0tive s*ills Ada0tive s*ills

" >outh and 0arent re0ort of im0act on 6ualit) of life >outh and 0arent re0ort of im0act on 6ualit) of life

" Correlation of ADHD (ith broad s0ectrumCorrelation of ADHD (ith broad s0ectrum0s)cho0atholog)0s)cho0atholog)

" m0act of ADHD on 0rosocial s*illsm0act of ADHD on 0rosocial s*ills


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Pre0aring the 5uturePre0aring the 5uture

" Data loc* +-'-Data loc* +-'-

" CERQA3> of ADHD treatmentCERQA3> of ADHD treatment

" The social costs of ADHDThe social costs of ADHD" The famil) costs of ADHDThe famil) costs of ADHD

" The 0ersonal burden to the child (ith ADHDThe 0ersonal burden to the child (ith ADHD

" Health utilit) of ADHD using EQ$2D and CHPHealth utilit) of ADHD using EQ$2D and CHP


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s

$o-or

eA>eaions

Mena& .ea&- $ommission


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Drugs and Ps)chological nterventionDrugs and Ps)chological ntervention

" nabilit) to 0urchase medicall) necessar) drugs has allocationnabilit) to 0urchase medicall) necessar) drugs has allocationim0licationsim0lications

• $o"n%stream costs to s&stem

' increased !ospitaliation rate

' increased acuteness at !ospitaliation

' decreased productivit&

' oor compliance

" !navailabilit) of drugs has allocation im0lications!navailabilit) of drugs has allocation im0lications

" ADHD is a disorder of 0erformance9 t is a disorder of ada0tive ADHD is a disorder of 0erformance9 t is a disorder of ada0tives*ills9 Medication minimi?es s)m0toms and 0rovides thes*ills9 Medication minimi?es s)m0toms and 0rovides theo00ortunit) but not the guarantee for s*ill develo0mento00ortunit) but not the guarantee for s*ill develo0ment Pills do not build s*illsPills do not build s*ills


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=te0s to Change=te0s to Change

" Recogni?e ADHD as common, im0airing, and treatable Recogni?e ADHD as common, im0airing, and treatable

" dentif) current services dentif) current services

" dentif) (here there are no services dentif) (here there are no services

There is not a single centre of ecellence for ADHD in adults in Canada There is not a single centre of ecellence for ADHD in adults in Canada

" Assign res0onsbilit) to care Assign res0onsbilit) to care

" Develo0 interministerial services Develo0 interministerial services

" t is ha00eningt is ha00ening

Iational nstitute for Health and Clinical Ecellence has 0roduced aIational nstitute for Health and Clinical Ecellence has 0roduced a

0ractice guideline (hich mandates centres of ecellence for ADHD0ractice guideline (hich mandates centres of ecellence for ADHD

throughout the ! including adult ADHD 8Phili0 Asherson: throughout the ! including adult ADHD 8Phili0 Asherson:

Holland has a national adult ADHD centre 8=andra ooi: (hichHolland has a national adult ADHD centre 8=andra ooi: (hich

0rovides consultation to a regional e0ert in each area0rovides consultation to a regional e0ert in each area

weiss the economic costs of adhd

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