The socioeconomic burden of adult attention-deficit/hyperactivity disorder in Spain


  • Maria Merino Vivactis Weber, Madrid - Spain
  • Paulina Maravilla-Herrera Vivactis Weber, Madrid - Spain
  • Teresa Martín Lorenzo Vivactis Weber, Madrid - Spain
  • Juan Antonio Arance Albolote Penitentiary, Granada - Spain
  • Julio Bobes Department of Medicine, Oviedo University, Oviedo - Spain, Department of Psychiatry, Asturias Central University Hospital (HUCA), Oviedo - Spain, Principado de Asturias Health Research Institute—ISPA, Oviedo - Spain, Principado de Asturias Neurosciences Center—INEUROPA, Oviedo - Spain, and Network Biomedical Research Centre on Mental Health—CIBERSAM, Oviedo - Spain
  • Montse Corrales Department of Psychiatry, Vall d’Hebron University Hospital, Barcelona - Spain
  • Fátima Guzmán Fundación Educación Activa, Madrid - Spain
  • María Morales Department of Psychiatry, Puerta de Hierro University Hospital, Majadahonda - Spain
  • Carlos Mur Department of Psychiatry, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany - Andorra



adult ADHD, burden of disease, healthcare system, social perspective, substance abuse, work productivity loss


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.


Download data is not yet available.


American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C.: American Psychiatric Association; 2013. DOI:

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. PMID:30453134 DOI:

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. PMID:25649325 DOI:

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. PMID:27866355 DOI:

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. PMID:30624968 DOI:

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. DOI:

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. PMID:33554324 DOI:

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. PMID:30195575 DOI:

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. 25317367 DOI:

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. DOI:

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. PMID:29422022 DOI:

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. DOI:

Instituto Nacional de Estadística. Estadística Continua de Población. Datos provisionales a 1 de enero de 2019. [Internet]. INE Instituto Nacional de Estadística 2019. 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. DOI:

Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Elvanse. Ficha técnica o resumen de las características del producto. October 2023.

Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Medikinet. Ficha técnica o resumen de las características del producto. Accessed October 2023.

Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Strattera. Ficha técnica o resumen de las características del producto. October 2023.

Consejo General de Colegios Oficiales de Farmacéuticos. BOTPLUS [Internet]. BOTPLUS 2020 October 2023.

Instituto Nacional de Estadística. Índice de Precios de Consumo. Base 2016. Medias anuales. Índices nacionales: general y de grupos ECOICOP 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. DOI:

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 PMID:33047627 DOI:

Quinn PD, Chang Z, Hur K, et al. ADHD medication and substance-related problems. Am J Psychiatry. 2017;174(9):877-885. PMID:28659039 DOI:

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. PMID:25158998 DOI:

Lichtenstein P, Larsson H, Zetterqvist J, et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2013;368(8):776. DOI:

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. PMID:24477798 DOI:

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. PMID:24942388 DOI:

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. PMID:24571924 DOI:

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. PMID:27774026 DOI:

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 (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. PMID:27749972 DOI:

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. DOI:

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. PMID:24464326 DOI:

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. October 2023.

Herranz Ramia Abogados. ¿Cuánto cuesta un divorcio actualmente en España? 2020. [Internet]. Herranz Ramia2018 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. PMID:22583562 DOI:

Johnson SM. The practice of emotionally focused couple therapy: creating connection. Routledge; 2019. DOI:

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. PMID:24964928 DOI:

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. DOI:

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!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. PMID:31288209 DOI:

Instituto Nacional de Estadística. Encuesta Anual de Estructura Salarial 2016. 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 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 October 2023.

Multas y accidentes de tráfico, ¿cuáles son las causas principales? 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. PMID:12164675 DOI:

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.

Inspección Técnica de Vehículos. Cómo recuperar los puntos del carnet de conducir [Internet]. 2018 October 2023.

Arpem. El precio medio de un seguro de coche en España fue de 479€ en 2019 October 2023

Acierto. El historial de siniestralidad del conductor, ¿qué es? 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. PMID:16669717 DOI:

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. PMID:18707766 DOI:

Francisco Sevilla Cáceres. ¿Cuanto tengo que pagarle a mi abogado? October 2023.

Aebi MF, Tiago MM. SPACE I - 2019 - Council of Europe Annual Penal Statistics: Prison populations. [Internet] Council of Europe; 2020, Available from Accessed August 21, 2020.



How to Cite

Merino, M., Maravilla-Herrera, P., Martín Lorenzo, T., Arance, J. A., Bobes, J., Corrales, M., Guzmán, F., Morales, M., & Mur, C. (2024). The socioeconomic burden of adult attention-deficit/hyperactivity disorder in Spain. Global and Regional Health Technology Assessment, 11(1), 82–93.



Original Research Articles


Received 2023-10-25
Accepted 2024-03-15
Published 2024-04-05


Most read articles by the same author(s)