The socioeconomic burden of adult attention-deficit/hyperactivity disorder in Spain
DOI:
https://doi.org/10.33393/grhta.2024.2697Keywords:
adult ADHD, burden of disease, healthcare system, social perspective, substance abuse, work productivity lossAbstract
Introduction: The symptoms of attention-deficit/hyperactivity disorder (ADHD) in adults highly interfere with function in multiple dimensions, increasing the economic burden associated with ADHD. The aim of this study was to explore the impact of ADHD in Spanish adults and estimate the associated economic burden within the healthcare, social, economic, and legal domains.
Methods: An economic model was developed from a social perspective using a bottom-up approach, based on the scientific literature and a multidisciplinary expert group.
Results: The cost incurred per diagnosed adult patient with ADHD included an annual cost of €15,652 and a one-time cost of €7,893 (3,035 M€ and 1,531 M€ for Spain, respectively). Regarding the annual cost, 50% was attributed to costs within the economic domain, of which 53% were work-absenteeism-related. Moreover, 28% was attributed to costs within the social domain, of which 74% were substance-abuse-related. Regarding the one-time cost, 52% was attributed to costs within the healthcare domain, of which approximately 50% were hospitalization-related costs. Moreover, 42% was attributed to costs within the legal domain, of which 62% were imprisonment-related costs.
Conclusions: This is the first report on the socioeconomic burden of ADHD in Spanish adults, shedding light on the large burden that adult ADHD poses on the healthcare system and society at large, as symptoms have been shown to impact almost every aspect of life. This is particularly important for undiagnosed/untreated patients with ADHD in Spain, as appropriate treatments have shown positive results in these areas and may reduce its associated socioeconomic burden.
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References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C.: American Psychiatric Association; 2013. DOI: https://doi.org/10.1176/appi.books.9780890425596
Kooij JJS, Bijlenga D, Salerno L, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56(1):14-34. https://doi.org/10.1016/j.eurpsy.2018.11.001 PMID:30453134 DOI: https://doi.org/10.1016/j.eurpsy.2018.11.001
Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: ameta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345-365. http://doi.wiley.com/10.1111/jcpp.12381 https://doi.org/10.1111/jcpp.12381 PMID:25649325 DOI: https://doi.org/10.1111/jcpp.12381
Fayyad J, Sampson NA, Hwang I, et al; WHO World Mental Health Survey Collaborators. The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Atten Defic Hyperact Disord. 2017;9(1):47-65. http://link.springer.com/10.1007/s12402-016-0208-3 https://doi.org/10.1007/s12402-016-0208-3 PMID:27866355 DOI: https://doi.org/10.1007/s12402-016-0208-3
Holst Y, Thorell LB. Functional impairments among adults with ADHD: acomparison with adults with other psychiatric disorders and links to executive deficits. Appl Neuropsychol Adult. 2020;27(3):243-255. https://www.tandfonline.com/doi/full/10.1080/23279095.2018.1532429 https://doi.org/10.1080/23279095.2018.1532429 PMID:30624968 DOI: https://doi.org/10.1080/23279095.2018.1532429
Chhibber A, Watanabe AH, Chaisai C, Veettil S, Chaiyakunapruk N. PMH20 economic burden of attention-deficit/hyperactivity disorder (ADHD): a global systematic review. Value Health. 2020;23:S203. https://www.valueinhealthjournal.com/article/S1098-3015(20)30828-7/abstract https://doi.org/10.1016/j.jval.2020.04.640 DOI: https://doi.org/10.1016/j.jval.2020.04.640
Chhibber A, Watanabe AH, Chaisai C, Veettil SK, Chaiyakunapruk N. Global economic burden of attention-deficit/hyperactivity disorder: a systematic review. PharmacoEconomics. 2021;39(4):399-420. https://doi.org/10.1007/s40273-020-00998-0 PMID:33554324 DOI: https://doi.org/10.1007/s40273-020-00998-0
Franke B, Michelini G, Asherson P, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol. 2018;28(10):1059-1088. https://linkinghub.elsevier.com/retrieve/pii/S0924977X18303031 https://doi.org/10.1016/j.euroneuro.2018.08.001 PMID:30195575 DOI: https://doi.org/10.1016/j.euroneuro.2018.08.001
Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01600. https://doi.org/10.4088/pcc.13r01600PMID: 25317367 DOI: https://doi.org/10.4088/PCC.13r01600
Du Rietz E, Jangmo A, Kuja-Halkola R, et al. Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD: a prospective register-based study. J Child Psychol Psychiatry. 2020 Sep;61(9):959-968. https://doi.org/10.1111/jcpp.13206PMID:32115717 DOI: https://doi.org/10.1111/jcpp.13206
Quintero J, Ramos-Quiroga JA, Sebastián JS, et al. Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis. BMC Psychiatry. 2018;18(1):40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806309/ https://doi.org/10.1186/s12888-017-1581-y PMID:29422022 DOI: https://doi.org/10.1186/s12888-017-1581-y
Ramos-Quiroga JA, Targhetta M, Gasche D, Rubio M, Perulero N. PND71 epidemiology of attention deficit hyperactivity disorders in Spain based on real-world data. Value Health. 2019;22:S750. https://linkinghub.elsevier.com/retrieve/pii/S1098301519342196 https://doi.org/10.1016/j.jval.2019.09.1841 DOI: https://doi.org/10.1016/j.jval.2019.09.1841
Instituto Nacional de Estadística. Estadística Continua de Población. Datos provisionales a 1 de enero de 2019. [Internet]. INE Instituto Nacional de Estadística 2019. https://www.ine.es/jaxiT3/Datos.htm?t=56934.Accessed October 2023.
Ramos-Quiroga JA, Tang JP, Solozabal M, Prado AD, Miñarro C, Callejo-Velasco D. PND124 a real-world data study to analyse the pharmacological treatment of attention deficit hyperactivity disorder in Spain. Value Health. 2019;22:S760. https://www.valueinhealthjournal.com/article/S1098-3015(19)34272-X/abstract https://doi.org/10.1016/j.jval.2019.09.1894 DOI: https://doi.org/10.1016/j.jval.2019.09.1894
Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Elvanse. Ficha técnica o resumen de las características del producto. https://cima.aemps.es/cima/pdfs/es/ft/77644/FT_77644.pdf.Accessed October 2023.
Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Medikinet. Ficha técnica o resumen de las características del producto. https://cima.aemps.es/cima/pdfs/es/ft/68545/FT_68545.pdf. Accessed October 2023.
Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Strattera. Ficha técnica o resumen de las características del producto. https://cima.aemps.es/cima/pdfs/es/ft/70123/FT_70123.pdf.Accessed October 2023.
Consejo General de Colegios Oficiales de Farmacéuticos. BOTPLUS [Internet]. BOTPLUS 2020 https://botplusweb.farmaceuticos.com/.Accessed October 2023.
Instituto Nacional de Estadística. Índice de Precios de Consumo. Base 2016. Medias anuales. Índices nacionales: general y de grupos ECOICOP http://www.ine.es/jaxiT3/Datos.htm?t=22553.Accessed October 2023.
Shemilt I, James T, Marcello M. A web-based tool for adjusting costs to a specific target currency and price year. Evid Policy. 2010;6(1):51-59. https://bristoluniversitypressdigital.com/view/journals/evp/6/1/article-p51.xml https://doi.org/10.1332/174426410X482999 DOI: https://doi.org/10.1332/174426410X482999
Sciberras E, Streatfeild J, Ceccato T, et al. Social and economic costs of attention-deficit/hyperactivity disorder across the lifespan. J Atten Disord. 2020;108705472096182 http://journals.sagepub.com/doi/10.1177/1087054720961828 PMID:33047627 DOI: https://doi.org/10.31234/osf.io/qcwp9
Quinn PD, Chang Z, Hur K, et al. ADHD medication and substance-related problems. Am J Psychiatry. 2017;174(9):877-885. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581231/ https://doi.org/10.1176/appi.ajp.2017.16060686 PMID:28659039 DOI: https://doi.org/10.1176/appi.ajp.2017.16060686
Chang Z, Lichtenstein P, Halldner L, et al. Stimulant ADHD medication and risk for substance abuse. J Child Psychol Psychiatry. 2014;55(8):878-885. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147667/ https://doi.org/10.1111/jcpp.12164 PMID:25158998 DOI: https://doi.org/10.1111/jcpp.12164
Lichtenstein P, Larsson H, Zetterqvist J, et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2013;368(8):776. https://www.nejm.org/doi/full/10.1056/NEJMoa1203241PMID:23425178 DOI: https://doi.org/10.1056/NEJMc1215531
Chang Z, Lichtenstein P, D’Onofrio BM, Sjölander A, Larsson H. Serious transport accidents in adults with ADHD, and the effect of medication: a population based study. JAMA Psychiatry. 2014;71(3):319-325. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949159/ https://doi.org/10.1001/jamapsychiatry.2013.4174 PMID:24477798 DOI: https://doi.org/10.1001/jamapsychiatry.2013.4174
Chen Q, Sjölander A, Runeson B, D’Onofrio BM, Lichtenstein P, Larsson H. Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study. BMJ. 2014;348(jun18 18):g3769. https://www.bmj.com/content/348/bmj.g3769 https://doi.org/10.1136/bmj.g3769 PMID:24942388 DOI: https://doi.org/10.1136/bmj.g3769
Caci H, Asherson P, Donfrancesco R, et al. Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey. CNS Spectr. 2015;20(2):112-121. https://doi.org/10.1017/S1092852914000078 PMID:24571924 DOI: https://doi.org/10.1017/S1092852914000078
Able SL, Haynes V, Hong J. Diagnosis, treatment, and burden of illness among adults with attention-deficit/hyperactivity disorder in Europe. Pragmat Obs Res. 2014;5:21-33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045018/ https://doi.org/10.2147/POR.S64348 PMID:27774026 DOI: https://doi.org/10.2147/POR.S64348
Ministerio de Sanidad, Consumo y Bienestar Social. Consulta Interactiva del SNS. Registro de Actividad de Atención Especializada RAE-CMBD. Coste medio APR. 2017. Públicos-SNS. Categoría CSS CIE10 244-Otras lesiones y afecciones debidas a causas externas. [Internet]. Portal Estadístico 2020 https://pestadistico.inteligenciadegestion.sanidad.gob.es/publicoSNS/C/rae-cmbd/rae-cmbd/diagnosticos-principales/diagnosticos-principales (Accessed October 2023)
Mosquera Nogueira J, Rodríguez-Míguez E. Intangible costs of alcohol dependence from the perspective of patients and their relatives: a contingent valuation study. Adicciones. 2018;30(2):111-122. https://doi.org/10.20882/adicciones.851 PMID:27749972 DOI: https://doi.org/10.20882/adicciones.851
Trapero‐Bertran M, Leidl R, Muñoz C, et al. Estimates of costs for modelling return on investment from smoking cessation interventions. Addiction [Internet] 2018 [cited 2020 Aug 19];113(Suppl 1):32–41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033022/ https://doi.org/10.1111/add.14091 DOI: https://doi.org/10.1111/add.14091
Piñeiro-Dieguez B, Balanzá-Martínez V, García-García P, Soler-López B; CAT Study Group. Psychiatric comorbidity at the time of diagnosis in adults with ADHD: the CAT Study. J Atten Disord. 2016;20(12):1066-1075. https://doi.org/10.1177/1087054713518240 PMID:24464326 DOI: https://doi.org/10.1177/1087054713518240
Oliva J, Rivera B. Los costes sociales del consumo de drogas ilegales en la Comunidad de Galicia. Presupuesto y Gasto Público. 2006;44:105-131.https://www.ief.es/Destacados/publicaciones/revistas/PGP.vbhtml.Accessed October 2023.
Herranz Ramia Abogados. ¿Cuánto cuesta un divorcio actualmente en España? 2020. [Internet]. Herranz Ramia2018 https://herranzramia.com/cuanto-cuesta-un-divorcio/.Accessed October 2023.
Brod M, Pohlman B, Lasser R, Hodgkins P. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes. 2012;10(1):47. https://doi.org/10.1186/1477-7525-10-47 PMID:22583562 DOI: https://doi.org/10.1186/1477-7525-10-47
Johnson SM. The practice of emotionally focused couple therapy: creating connection. Routledge; 2019. https://doi.org/10.4324/9781351168366 DOI: https://doi.org/10.4324/9781351168366
Ljung T, Chen Q, Lichtenstein P, Larsson H. Common etiological factors of attention-deficit/hyperactivity disorder and suicidal behavior: a population-based study in Sweden. JAMA Psychiatry. 2014;71(8):958-964. https://doi.org/10.1001/jamapsychiatry.2014.363 PMID:24964928 DOI: https://doi.org/10.1001/jamapsychiatry.2014.363
Alfonso-Sánchez JL, Martin-Moreno JM, Martinez IM, Martinez AA. Epidemiological study and cost analysis of suicide in Spain: over 100 years of evolution. Arch Suicide Res. 2020;24(sup2):S356-S369. https://doi.org/10.1080/13811118.2019.1612802PMID:31079554 DOI: https://doi.org/10.1080/13811118.2019.1612802
Hartge J, Toledo P. Attention Deficit Hyperactivity Disorder (ADHD) and its comorbid mental disorders: an evaluation of their labor market outcomes. J Ment Health Policy Econ. 2018;21(3):105-121. PMID:30530871
Instituto Nacional de Estadística. Encuestas de estructura salarial. Ganancia media anual por trabajador. [Internet]. INE2017 https://www.ine.es/jaxiT3/Datos.htm?t=28189#!tabs-tabla.Accessed October 2023.
Daley D, Jacobsen RH, Lange AM, Sørensen A, Walldorf J. The economic burden of adult attention deficit hyperactivity disorder: asibling comparison cost analysis. Eur Psychiatry. 2019;61:41-48. https://linkinghub.elsevier.com/retrieve/pii/S0924933819301099 https://doi.org/10.1016/j.eurpsy.2019.06.011 PMID:31288209 DOI: https://doi.org/10.1016/j.eurpsy.2019.06.011
Instituto Nacional de Estadística. Encuesta Anual de Estructura Salarial 2016. https://www.ine.es/prensa/ees_2016.pdf.Accessed October 2023.
Blasco de Luna FJ, Barceló Larran D, Blázquez Agudo EM, et al. VIII Informe Adecco sobre absentismo. [Internet] The Adecco Group Institute; 2019, Available from https://www.adeccoinstitute.es/wp-content/uploads/2019/06/VIII-Informe-Absentismo.pdf. Accessed August 21, 2020.
de España B. Encuesta Financiera de las Familias (EFF) 2017: métodos, resultados y cambios desde 2014 [Internet]. Banco de España; 2020 https://www.bde.es/bde/es/areas/estadis/estadisticas-por/encuestas-hogar/relacionados/Encuesta_Financi/eff_2017.html.Accessed October 2023.
Multas y accidentes de tráfico, ¿cuáles son las causas principales? https://www.ocu.org/coches/coches/noticias/multas-y-accidentes-trafico-causas.Accessed October 2023.
Barkley RA, Murphy KR, Dupaul GI, Bush T. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. J Int Neuropsychol Soc. 2002;8(5):655-672. https://doi.org/10.1017/S1355617702801345 PMID:12164675 DOI: https://doi.org/10.1017/S1355617702801345
BOE núm. 85. Ley 6/2014, de 7 de abril, por la que se modifica el texto articulado de la Ley sobre Tráfico, Circulación de Vehículos a Motor y Seguridad Vial, aprobado por el Real Decreto Legislativo 339/1990, de 2 de marzo. https://www.boe.es/buscar/act.php?id=BOE-A-2014-3715&tn=1&p=20181120
Inspección Técnica de Vehículos. Cómo recuperar los puntos del carnet de conducir [Internet]. ITV.com.es 2018 https://itv.com.es/como-recuperar-puntos-del-carnet-de-conducir.Accessed October 2023.
Arpem. El precio medio de un seguro de coche en España fue de 479€ en 2019 https://www.arpem.com/noticias/seguros/informacion/evolucion-precios-seguros-coche-2019-3834710-n.html.Accessed October 2023
Acierto. El historial de siniestralidad del conductor, ¿qué es? https://www.acierto.com/seguros-coche/historial-siniestralidad/.Accessed October 2023.
Biederman J, Faraone SV, Spencer TJ, Mick E, Monuteaux MC, Aleardi M. Functional impairments in adults with self-reports of diagnosed ADHD: acontrolled study of 1001 adults in the community. J Clin Psychiatry. 2006;67(4):524-540. https://www.psychiatrist.com/jcp/article/pages/2006/v67n04/v67n0403.aspx https://doi.org/10.4088/JCP.v67n0403 PMID:16669717 DOI: https://doi.org/10.4088/JCP.v67n0403
Mannuzza S, Klein RG, Moulton JL III. Lifetime criminality among boys with attention deficit hyperactivity disorder: a prospective follow-up study into adulthood using official arrest records. Psychiatry Res. 2008;160(3):237-246. http://www.sciencedirect.com/science/article/pii/S0165178107003976 https://doi.org/10.1016/j.psychres.2007.11.003 PMID:18707766 DOI: https://doi.org/10.1016/j.psychres.2007.11.003
Francisco Sevilla Cáceres. ¿Cuanto tengo que pagarle a mi abogado? https://www.mundojuridico.info/cuanto-tengo-que-pagarle-a-mi-abogado/.Accessed October 2023.
Aebi MF, Tiago MM. SPACE I - 2019 - Council of Europe Annual Penal Statistics: Prison populations. [Internet] Council of Europe; 2020, Available from http://wp.unil.ch/space/files/2020/04/200405_FinalReport_SPACE_I_2019.pdf. Accessed August 21, 2020.
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Accepted 2024-03-15
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