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.
Subject(s)
Attention Deficit Disorder with Hyperactivity/economics , Cost of Illness , Health Care Costs/statistics & numerical data , Adolescent , Attention Deficit Disorder with Hyperactivity/epidemiology , Caregivers/economics , Child , Cross-Sectional Studies , Demography , Employment/economics , Female , Humans , Male , Spain/epidemiologyABSTRACT
INTRODUCTION: ADHD is a clinical entity that persists during adolescence and even into adulthood in many cases. Assuming that most adults with ADHD will not have been diagnosed in childhood, the GEDA-A group (Adult ADHD study group) considered that it was important to assess how much knowledge the clinicians had about ADHD in order to provide for the identification of the disorder in the adult. METHODOLOGY: A cross-sectional survey to be fill out by specialists involved in the diagnosis and treatment of ADHD was designed. This survey included questions on awareness of the disease in the different stages of life (childhood, adolescence and adulthood). RESULTS: 484 clinicians, with a mean age of 45 years (95% CI 44-46) and 17 years of professional experience (95% CI 16-18) filled out the survey. 384 were psychiatrists (79.5%), 67 neurologists (13.9%) and 19 addictive behavior specialists (3.9%). When their opinions were compared about the diagnosis and treatment of ADHD in childhood, adolescence and adulthood, significant differences of opinion were found regarding the three stages in all the dimensions analyzed (p<0.0001). Assessment in adulthood systematically showed a lower degree of awareness compared to ADHD in childhood and adolescence. CONCLUSIONS: In the clinician's opinion, ADHD in adulthood is a clinical entity that is less defined and whose diagnosis is not as clear, compared to ADHD in the other stages in life. The GEDA-A group suggests that it is necessary to have more comprehensive training that makes the diagnosis and treatment of ADHD in adults easier.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Attitude of Health Personnel , Surveys and Questionnaires , Adult , Age Factors , Attention Deficit Disorder with Hyperactivity/diagnosis , Cross-Sectional Studies , Female , Humans , Male , Middle AgedABSTRACT
Introducción. El TDAH es una entidad clínica que persiste en muchos casos, durante la adolescencia incluso en la edad adulta. Asumiendo que la mayor parte de los adultos con TDAH no habrán sido diagnosticados en la infancia, el grupo de trabajo GEDA-A (Grupo de Estudio para el Déficit de Atención en el Adulto) consideró importante valorar el grado de conocimiento del TDAH por el clínico, para facilitarla identificación del trastorno en el adulto. Metodología. Se diseñó una encuesta transversal, completada por especialistas implicados en el diagnóstico y tratamiento del TDAH. Se incluyeron preguntas sobre el conocimiento de la patología en las distintas etapas de la vida (infancia, adolescencia y edad adulta). Resultados. 484 clínicos, con edad media de 45 años (IC95% 44 a 46) y 17 años de ejercicio profesional (IC95%16 a 18) completaron la encuesta. 384 eran psiquiatras (79,5%), 67 neurólogos (13,9%) y 19 especialistas en conductas adictivas (3,9%). En la comparación de sus opiniones sobre el diagnóstico y el tratamiento del TDAH en la infancia, adolescencia y edad adulta, se observaron diferencias de opinión significativas respecto a las tres etapas, en todas las dimensiones analizadas (p<0,0001). La valoración en la edad adulta fue sistemáticamente de menor grado de conocimiento en comparación con el TDAH en la infancia y la adolescencia. Conclusiones. En opinión de los clínicos, el TDAH en la edad adulta es una entidad clínica menos definida y con un diagnóstico menos claro, en comparación con las otras etapas de la vida. El Grupo GEDA-A sugiere que es necesaria una formación más completa que facilite el diagnóstico y tratamiento del TDAH en el adulto (AU)
Introduction: ADHD is a clinical entity that persists during adolescence and even into adulthood in many cases. Assuming that most adults with ADHD will not have been diagnosed in childhood, the GEDA-A group (Adult ADHD study group) considered that it was important to assess how much knowledge the clinicians had about ADHD in order to provide for the identification of the disorder in the adult. Methodology: A cross-sectional survey to be fill out by specialists involved in the diagnosis and treatment of ADHD was designed. This survey included questions on awareness of the disease in the different stages of life (childhood, adolescence and adulthood). Results: 484 clinicians, with a mean age of 45 years (95% CI 44-46) and 17 years of professional experience (95% CI 16-18) filled out the survey. 384 were psychiatrists (79.5%), 67 neurologists (13.9%) and 19 addictive behavior specialists (3.9%). When their opinions were compared about the diagnosis and treatment of ADHD in childhood, adolescence and adulthood, significant differences of opinion were found regarding the three stages in all the dimensions analyzed (p<0.0001). Assessment in adulthood systematically showed a lower degree of awareness compared to ADHD in childhood and adolescence. Conclusions: In the clinicians opinion, ADHD in adulthood is a clinical entity that is less defined and whose diagnosis is not as clear, compared to ADHD in the other stages in life. The GEDA-A group suggests that it is necessary to have more comprehensive training that makes the diagnosis and treatment of ADHD in adults easier (AU)