Utilization and cost of health care services for children with attention-deficit/hyperactivity disorder

Background. Despite an increasing prevalence of diagnosed attention-deficit /hyperactivity disorder (ADHD) among children, the impact of ADHD on utiliz ation and costs of health care services is largely unknown. Objective. To examine differences in health care utilization and costs betw een children with and without ADHD. Design. Retrospective matched cohort study conducted from January 1 to Dece mber 31, 1997. Setting. Health maintenance organization in western Washington State. Participants. Children aged 3 through 17 years who were continuously enroll ed in the health maintenance organization and used services during 1997 wer e eligible. Children were identified with ADHD if they had a diagnosis of A DHD or a prescription for a stimulant medication using automated patient fi les. Children without ADHD were randomly selected as controls and matched 4 :1 to children with ADHD on age and sex. Outcome Measure. Utilization and costs of specific categories of health car e services. Results. A total of 2992 children (5.2%) were identified with ADHD. Childre n with ADHD incurred significantly greater per capita total costs ($1465 vs $690) than children without ADHD. Children with ADHD had 9.9 times more ou tpatient mental health visits (1.35/year vs 0.14/year), 3.4 times more phar macy fills (11.25/year vs 3.30/year), and 1.6 times more primary care visit s (3.84/year vs 2.36/year) than children without ADHD. The adjusted increme ntal costs were estimated to be $375 (95% confidence interval: $336-$416) f or children with ADHD alone and $812 (95% confidence interval: $671-$973) f or children with ADHD plus coexisting mental health disorders. Conclusions. Children with ADHD use significantly more health care resource s and incur significantly higher costs than children without ADHD. Coexisti ng mental health disorders substantially increase the cost of treating ADHD . Resource allocation decisions should consider the contributions of primar y care, outpatient mental health, and pharmacy costs to the overall costs o f care for children with ADHD.