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