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Healthcare Use, Social Burden and Costs of Children With and Without ADHD in Flanders, Belgium

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Abstract

Background: The purpose of this study was to provide quantitative information on the economic, social and emotional burden borne by families of children with attention-deficit hyperactivity disorder (ADHD) and on the public healthcare costs of a child with ADHD in Flanders, Belgium, and to compare costs of ADHD children with those of siblings without the disorder.

Methods: A pilot-tested questionnaire was sent to all members of the Flemish ADHD society in February 2003. Parents were asked to record utilisation of healthcare, social care and other non-medical resources for their ADHD child and his/her sibling. In addition, data were collected on ADHD severity (IOWA-Conners Rating Scale) and on the sociodemographic and economic characteristics of the parents. Parents’ out-of-pocket and public annual costs were calculated using tariffs. These costs were corrected for several confounding variables using general linear model (GLM) estimates.

Results: ADHD affects school results and parents’ productivity and places a psychological and emotional burden on the family. Childhood ADHD also results in a significantly higher use of healthcare: ADHD children have a significantly higher probability of visiting a general practitioner (60.3% vs 37.4%) and a specialist (50.9% vs 12.9%); they also visit the emergency department significantly more often (26% vs 12.1%), and they are hospitalised significantly more often (14% vs 8.4%). Consequently, Flemish children with ADHD incur significantly higher medical costs than their siblings without the disorder. Even after correction for several covariates, these cost differences are still striking. In fact, compared with their sibling, the annual cost for an ADHD child is more than six times higher for the parent (€588.3 vs €91.5), and public costs are twice as high (€779 vs €371.3) [year of costing 2002].

Conclusions: Childhood ADHD results in significantly higher use of healthcare and adversely affects academic achievements and parents’ productivity.

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Acknowledgements

This study was performed by the University of Antwerp with the collaboration of the patient organisation ‘Zit Stil’; the study was commissioned and funded by Janssen Pharmaceutica. We are very grateful to ‘Zit Stil’ for permission to use their mailing list to contact the ADHD patients. We would also like to thank Ines Adriaenssen and Mike Ingham from Janssen Pharmaceutica for their advice on the contents and layout of the questionnaire.

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Correspondence to Annemieke De Ridder.

Appendices

Appendices

Appendix 1

List of variables used in the GLM estimations:

Dependent variables:

cost_par: total annual out-of-pocket costs

cost_gov: total annual public costs

Explanatory variables:

adhd: dummy variable (1 if child is diagnosed with ADHD, 0 if child is not diagnosed with ADHD)

iowa_0: dummy variable (1 if child is diagnosed with ADHD and has a score between 0 and 15 on IOWA, 0 otherwise)

iowa_1: dummy variable (1 if child is diagnosed with ADHD and has a score between 16 and 22 on IOWA, 0 otherwise)

iowa_2: dummy variable (1 if child is diagnosed with ADHD and has a score >22 for IOWA, 0 otherwise)

iowa_mis: dummy variable (1 if child is diagnosed with ADHD and has a missing value for IOWA because the child always takes medication, 0 otherwise)

nadhd: # of children with ADHD in the household

sex: dummy variable (1 if male, 0 if female)

age: age of the child

othdrug: dummy variable (1 if child takes [non-ADHD related] drugs, 0 otherwise)

agepar: age of the parent that filled in the questionnaire

nhousehold: number of household members

married: marital status of the parents (1 if married or living together, 0 otherwise)

job_mother: dummy variable (1 if mother has a job, 0 if mother is unemployed)

job_father: dummy variable (1 if father has a job, 0 if father is unemployed)

education_2: dummy variable, education of the parents (1 if secondary education)

education_3: dummy variable, education of the parents (1 if higher education)

statute: national health service statute of the parent that filled in the questionnaire (1 if general regulation, 0 if self-employed regulation)

high_reimb: dummy variable (1 if child is entitled to higher reimbursement, 0 otherwise)

income_eq: equivalent income of the household

fight_sibl: does the child often fight with his/her siblings (ordinal variable)

fight_friend: does the child often fight with his/her friends (ordinal variable)

reckless: does the child often exhibit reckless behaviour (ordinal variable)

dangerous: does the child often exhibit dangerous behaviour (ordinal variable)

Appendix 2

See table V.

Table V
figure Tab5figure Tab5figure Tab5

Detailed descriptive statistics of the results (proportions and p-values)

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De Ridder, A., De Graeve, D. Healthcare Use, Social Burden and Costs of Children With and Without ADHD in Flanders, Belgium. Clin. Drug Investig. 26, 75–90 (2006). https://doi.org/10.2165/00044011-200626020-00003

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