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Seddio K, Pollack D, Crawford H, Lewis J. Attention-deficit/hyperactivity disorder (ADHD) and anxiety during the COVID-19 pandemic: Implications for internalizing behaviors in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1159-1165. [PMID: 35622987 DOI: 10.1080/07448481.2022.2069469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
Objective: The purpose of this study was to delineate the moderating roles of negative experiences related to the coronavirus disease 2019 (COVID-19) on the association between Attention-Deficit/Hyperactivity Disorder symptoms and anxiety symptoms and internalizing behaviors during Fall 2020. Method: Participants were 200 college students. Using a moderated moderation model, researchers found that attention-deficit/hyperactivity disorder symptoms predicted anxiety symptoms for those who internalized behaviors and experienced COVID-19 more negatively. Results: Results suggested that ADHD symptoms were playing a role in the manifestation of anxiety symptoms during the COVID-19 pandemic and that college students who internalize behaviors experienced worsened ADHD symptoms. Conclusion: Clinical implications underscore the importance of providing mental health resources for students on campus, particularly during the COVID-19 pandemic. Specialized treatment may include help with developing time management skills and teaching interventions such as mindfulness exercises that may help alleviate anxiety and improve attention and concentration.
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Affiliation(s)
- Kaylee Seddio
- Department of Psychology, CFLE, Utica College, Utica, New York, USA
| | - Deborah Pollack
- Department of Psychology, Utica College, Utica, New York, USA
| | - Haley Crawford
- Credence Management Solutions, LLC, Vienna, Virginia, USA
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2
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Hanson RF, Zhu V, Are F, Espeleta H, Wallis E, Heider P, Kautz M, Lenert L. Initial development of tools to identify child abuse and neglect in pediatric primary care. BMC Med Inform Decis Mak 2023; 23:266. [PMID: 37978498 PMCID: PMC10656827 DOI: 10.1186/s12911-023-02361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Child abuse and neglect (CAN) is prevalent, associated with long-term adversities, and often undetected. Primary care settings offer a unique opportunity to identify CAN and facilitate referrals, when warranted. Electronic health records (EHR) contain extensive information to support healthcare decisions, yet time constraints preclude most providers from thorough EHR reviews that could indicate CAN. Strategies that summarize EHR data to identify CAN and convey this to providers has potential to mitigate CAN-related sequelae. This study used expert review/consensus and Natural Language Processing (NLP) to develop and test a lexicon to characterize children who have experienced or are at risk for CAN and compared machine learning methods to the lexicon + NLP approach to determine the algorithm's performance for identifying CAN. METHODS Study investigators identified 90 CAN terms and invited an interdisciplinary group of child abuse experts for review and validation. We then used NLP to develop pipelines to finalize the CAN lexicon. Data for pipeline development and refinement were drawn from a randomly selected sample of EHR from patients seen at pediatric primary care clinics within a U.S. academic health center. To explore a machine learning approach for CAN identification, we used Support Vector Machine algorithms. RESULTS The investigator-generated list of 90 CAN terms were reviewed and validated by 25 invited experts, resulting in a final pool of 133 terms. NLP utilized a randomly selected sample of 14,393 clinical notes from 153 patients to test the lexicon, and .03% of notes were identified as CAN positive. CAN identification varied by clinical note type, with few differences found by provider type (physicians versus nurses, social workers, etc.). An evaluation of the final NLP pipelines indicated 93.8% positive CAN rate for the training set and 71.4% for the test set, with decreased precision attributed primarily to false positives. For the machine learning approach, SVM pipeline performance was 92% for CAN + and 100% for non-CAN, indicating higher sensitivity than specificity. CONCLUSIONS The NLP algorithm's development and refinement suggest that innovative tools can identify youth at risk for CAN. The next key step is to refine the NLP algorithm to eventually funnel this information to care providers to guide clinical decision making.
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Affiliation(s)
| | - Vivienne Zhu
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Paul Heider
- Medical University of South Carolina, Charleston, SC, USA
| | - Marin Kautz
- Medical University of South Carolina, Charleston, SC, USA
| | - Leslie Lenert
- Medical University of South Carolina, Charleston, SC, USA
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Almai AM, Salpekar JA. Healthcare utilisation in the United Arab Emirates for children with attention-deficit hyperactivity disorder and comorbidities. BJPsych Int 2023; 20:61-63. [PMID: 37531226 PMCID: PMC10387415 DOI: 10.1192/bji.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/23/2023] [Indexed: 08/04/2023] Open
Abstract
The prevalence of attention-deficit hyperactivity disorder is consistent worldwide. Psychiatric comorbidities are common, although less is known about how those comorbidities affect utilisation of healthcare services. Access to paediatric mental healthcare is a challenge in many regions. However, access to care in the United Arab Emirates (UAE) is supported by a well-established healthcare infrastructure with widely available primary care physicians. A review of diagnosis codes suggests that a clear correlation exists between the number of comorbidities and increased utilisation of available mental health services. Infrastructure in the UAE may represent a successful model for paediatric mental healthcare.
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Affiliation(s)
- Ahmad M Almai
- Consultant child and adolescent psychiatrist; Director of Residency Training, Department of Psychiatry, Johns Hopkins Aramco Health Center, Dhahran, Kingdom of Saudi Arabia. Email
| | - Jay A Salpekar
- Director of the Neuropsychiatry Center, Kennedy Krieger Institute, Baltimore, Maryland, USA; Associate Professor of Psychiatry and Neurology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mora T, Puig-Junoy J, Jacobs R, Cid J. Differential costs for the non-adult ADHD population in Catalonia. HEALTH ECONOMICS REVIEW 2023; 13:24. [PMID: 37086372 PMCID: PMC10122377 DOI: 10.1186/s13561-023-00437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is young children's most common mental health disorder. We aim to provide causal estimates of the differential costs for the non-adult population with ADHD. We used longitudinal administrative data covering the non-adult population over five years and different healthcare providers (general practitioners, hospitalisations and emergency departments, visits to mental healthcare centres-day-care or hospitals) of 1,101,215 individuals in Catalonia (Spain). We also include the consumption of pharmaceuticals and cognitive therapies. We instrumented ADHD diagnosis by the probability of being diagnosed by the most visited healthcare provider based on individual monthly visits to the provider in which this visit was related to ADHD and the density of professionals in the different mental health providers. After using matching procedures to include a proper control group, we estimated two-part and finite mixture models. Our results indicate that ADHD children and adolescents displayed 610€ higher annual health direct costs compared to not diagnosed counterparts. We provide average costs disentangling the sample by age boundaries, gender, and comorbidities to offer values for cost-effective analyses and incremental costs after diagnosis, which is around 400€. A significant differential annual direct health cost for the non-adult population with ADHD is determined, which will be helpful for cost-effectiveness analysis and complete cost-of-illness studies.
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Affiliation(s)
- Toni Mora
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, 08017, Spain.
| | - Jaume Puig-Junoy
- Universitat Pompeu Fabra-Barcelona School of Management (UPF-BSM), Barcelona, Spain
| | - Rowena Jacobs
- Centre for Health Economics (CHE), University of York, York, UK
| | - Jordi Cid
- Institut d'Assistència Sanitària (IAS) and Mental Health & Addiction Research Group (IDIBGI), Girona, Spain
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Girela-Serrano B, Miguélez C, Porras-Segovia AA, Díaz C, Moreno M, Peñuelas-Calvo I, Roselló R, Baca-García E, Carballo JJ. Predictors of mental health service utilization as adolescents with attention deficit hyperactivity disorder transition into adulthood. Early Interv Psychiatry 2023; 17:252-262. [PMID: 35706409 DOI: 10.1111/eip.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/01/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) symptoms may persist into adulthood and are likely to cause great problems in young adults. To date, few studies have explored the characteristics of patients diagnosed with ADHD that might influence the utilization of adult mental health services (AMHS). We aimed to examine and identify predictive symptoms of AMHS. METHODS We analysed data from 114 participants diagnosed with ADHD from a cohort of adolescents recruited at the age of 12-17 years, who, at the time of data analysis, were over 18 years old. RESULTS Among AMHS users, hyperactivity/impulsivity measures were significantly more severe (t = 2.668, df = 112, p < .001), ADHD combined subtype diagnosis (χ2 = 4.66, df = 1, p = .031) was more frequent and dysregulation profile in the SDQ-P was also significantly higher (t = -2.497, df = 109, p = .014). However, the dysregulation profile did not remain statistically significant after controlling for type of AMHS contact. CONCLUSIONS Our findings suggest that adolescents with ADHD are more likely continue their care under AMHS if they present more severe symptoms of hyperactivity/impulsivity and emotional dysregulation. The better characterization of the patient profile will help clinicians to early identify groups at-risk and to tailor interventions and prevention strategies.
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Affiliation(s)
- Braulio Girela-Serrano
- Westminster Child & Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Imperial College, London, UK
| | - Carolina Miguélez
- Department of Child and Adolescent Psychiatry, Hospital Niño Jesús, Madrid, Spain
| | - Alejandro Albán Porras-Segovia
- Division of Psychiatry, Imperial College, London, UK
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | | | - Manon Moreno
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | | | - Rocio Roselló
- Division of Psychiatry, Imperial College, London, UK
- Department of Psychiatry, University Hospital Doctor Peset of Valencia & University of Valencia, Valencia, Spain
| | - Enrique Baca-García
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Infanta Elena, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- Université de Nîmes, Nîmes, France
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An electronic health record (EHR) phenotype algorithm to identify patients with attention deficit hyperactivity disorders (ADHD) and psychiatric comorbidities. J Neurodev Disord 2022; 14:37. [PMID: 35690720 PMCID: PMC9188139 DOI: 10.1186/s11689-022-09447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background In over half of pediatric cases, ADHD presents with comorbidities, and often, it is unclear whether the symptoms causing impairment are due to the comorbidity or the underlying ADHD. Comorbid conditions increase the likelihood for a more severe and persistent course and complicate treatment decisions. Therefore, it is highly important to establish an algorithm that identifies ADHD and comorbidities in order to improve research on ADHD using biorepository and other electronic record data. Methods It is feasible to accurately distinguish between ADHD in isolation from ADHD with comorbidities using an electronic algorithm designed to include other psychiatric disorders. We sought to develop an EHR phenotype algorithm to discriminate cases with ADHD in isolation from cases with ADHD with comorbidities more effectively for efficient future searches in large biorepositories. We developed a multi-source algorithm allowing for a more complete view of the patient’s EHR, leveraging the biobank of the Center for Applied Genomics (CAG) at Children’s Hospital of Philadelphia (CHOP). We mined EHRs from 2009 to 2016 using International Statistical Classification of Diseases and Related Health Problems (ICD) codes, medication history and keywords specific to ADHD, and comorbid psychiatric disorders to facilitate genotype-phenotype correlation efforts. Chart abstractions and behavioral surveys added evidence in support of the psychiatric diagnoses. Most notably, the algorithm did not exclude other psychiatric disorders, as is the case in many previous algorithms. Controls lacked psychiatric and other neurological disorders. Participants enrolled in various CAG studies at CHOP and completed a broad informed consent, including consent for prospective analyses of EHRs. We created and validated an EHR-based algorithm to classify ADHD and comorbid psychiatric status in a pediatric healthcare network to be used in future genetic analyses and discovery-based studies. Results In this retrospective case-control study that included data from 51,293 subjects, 5840 ADHD cases were discovered of which 46.1% had ADHD alone and 53.9% had ADHD with psychiatric comorbidities. Our primary study outcome was to examine whether the algorithm could identify and distinguish ADHD exclusive cases from ADHD comorbid cases. The results indicate ICD codes coupled with medication searches revealed the most cases. We discovered ADHD-related keywords did not increase yield. However, we found including ADHD-specific medications increased our number of cases by 21%. Positive predictive values (PPVs) were 95% for ADHD cases and 93% for controls. Conclusion We established a new algorithm and demonstrated the feasibility of the electronic algorithm approach to accurately diagnose ADHD and comorbid conditions, verifying the efficiency of our large biorepository for further genetic discovery-based analyses. Trial registration ClinicalTrials.gov, NCT02286817. First posted on 10 November 2014. ClinicalTrials.gov, NCT02777931. First posted on 19 May 2016. ClinicalTrials.gov, NCT03006367. First posted on 30 December 2016. ClinicalTrials.gov, NCT02895906. First posted on 12 September 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09447-9.
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Havewala M, Lorenzo NE, Seddio K, Oddo LE, Novick DR, Fox NA, Chronis-Tuscano A. Understanding Co-Occurring ADHD and Anxiety Symptoms within a Developmental Framework: Risk and Protective Factors of Early Temperament and Peer Relations. Res Child Adolesc Psychopathol 2022; 50:853-866. [DOI: 10.1007/s10802-021-00891-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
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Straub L, Bateman BT, Hernandez-Diaz S, York C, Zhu Y, Suarez EA, Lester B, Gonzalez L, Hanson R, Hildebrandt C, Homsi J, Kang D, Lee KWK, Lee Z, Li L, Longacre M, Shah N, Tukan N, Wallace F, Williams C, Zerriny S, Mogun H, Huybrechts KF. Validity of claims-based algorithms to identify neurodevelopmental disorders in children. Pharmacoepidemiol Drug Saf 2021; 30:1635-1642. [PMID: 34623720 DOI: 10.1002/pds.5369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/13/2021] [Accepted: 09/17/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE To validate healthcare claim-based algorithms for neurodevelopmental disorders (NDD) in children using medical records as the reference. METHODS Using a clinical data warehouse of patients receiving outpatient or inpatient care at two hospitals in Boston, we identified children (≤14 years between 2010 and 2014) with at least one of the following NDDs according to claims-based algorithms: autism spectrum disorder/pervasive developmental disorder (ASD), attention deficit disorder/other hyperkinetic syndromes of childhood (ADHD), learning disability, speech/language disorder, developmental coordination disorder (DCD), intellectual disability, and behavioral disorder. Fifty cases per outcome were randomly sampled and their medical records were independently reviewed by two physicians to adjudicate the outcome presence. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated. RESULTS PPVs were 94% (95% CI, 83%-99%) for ASD, 88% (76%-95%) for ADHD, 98% (89%-100%) for learning disability, 98% (89%-100%) for speech/language disorder, 82% (69%-91%) for intellectual disability, and 92% (81%-98%) for behavioral disorder. A total of 19 of the 50 algorithm-based cases of DCD were confirmed as severe coordination disorders with functional impairment, with a PPV of 38% (25%-53%). Among the 31 false-positive cases of DCD were 7 children with coordination deficits that did not persist throughout childhood, 7 with visual-motor integration deficits, 12 with coordination issues due to an underlying medical condition and 5 with ADHD and at least one other severe NDD. CONCLUSIONS PPVs were generally high (range: 82%-98%), suggesting that claims-based algorithms can be used to study NDDs. For DCD, additional criteria are needed to improve the classification of true cases.
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Affiliation(s)
- Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Cassandra York
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yanmin Zhu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Suarez
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Barry Lester
- Center for the Study of Children at Risk, Department of Pediatrics, Alpert Medical School of Brown University, and Women and Infants Hospital, Providence, Rhode Island, USA
| | - Lyndon Gonzalez
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ryan Hanson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
| | - Clara Hildebrandt
- Department of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joseph Homsi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Kang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ken W K Lee
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary Lee
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Linda Li
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, California, USA
| | - Mckenna Longacre
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nidhi Shah
- Department of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Natalie Tukan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Frances Wallace
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Williams
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Salim Zerriny
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Garcia-Argibay M, Pandya E, Ahnemark E, Werner-Kiechle T, Andersson LM, Larsson H, Du Rietz E. Healthcare utilization and costs of psychiatric and somatic comorbidities associated with newly diagnosed adult ADHD. Acta Psychiatr Scand 2021; 144:50-59. [PMID: 33749845 DOI: 10.1111/acps.13297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/22/2021] [Accepted: 03/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychiatric and somatic problems in young adulthood have been found to be main drivers of costs in individuals with childhood ADHD. However, knowledge of the patterns of healthcare utilization and costs of comorbidities in middle-aged adults with newly diagnosed ADHD is very limited. METHOD We studied individuals born 1966-1978 (from the Swedish Total Population Register) with newly diagnosed ADHD between the ages of 30-45 years and individuals without ADHD matched on birthdate, birth county, and sex. Healthcare utilization and expenditure for psychiatric and somatic disorders were obtained over four years (two years pre- and post-initial ADHD diagnosis). RESULTS Middle-aged adults with newly diagnosed ADHD showed higher levels of healthcare utilization and costs (outpatient, inpatient, medications) for psychiatric and somatic comorbidities relative to adults without ADHD, both before and after the initial diagnosis. Females showed greater average group differences across the study period for medication prescriptions than males. Total incremental annual costs per capita were €2478.76 in adults with ADHD relative to those without, and costs were mainly driven by inpatient care. Psychiatric outpatient visits were statistically significantly higher the year before the ADHD diagnosis compared with two years before and after the diagnosis. CONCLUSION This study demonstrates the substantial burden of psychiatric and somatic comorbidities in middle-aged adults newly diagnosed with ADHD. Psychiatric outpatient visits peaked in the year leading up to the ADHD diagnosis. Findings further suggested that females with ADHD may seek more treatment for comorbidities than males, which may reflect a general female tendency.
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Affiliation(s)
| | - Ekta Pandya
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ewa Ahnemark
- Shire Sweden AB, a Takeda Company, Stockholm, Sweden
| | | | | | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Chhibber A, Watanabe AH, Chaisai C, Veettil SK, Chaiyakunapruk N. Global Economic Burden of Attention-Deficit/Hyperactivity Disorder: A Systematic Review. PHARMACOECONOMICS 2021; 39:399-420. [PMID: 33554324 DOI: 10.1007/s40273-020-00998-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children and adults. Previous systematic reviews have provided estimates of ADHD-associated costs but were limited to the USA and Europe. OBJECTIVES This study aimed to systematically summarise all global evidence on the economic burden of ADHD. METHODS A systematic search for published studies on costs of ADHD was conducted in EconLit, EMBASE, PubMed, ERIC, and PsycINFO. Additional literature was identified by searching the reference lists of eligible studies. The quality of the studies was assessed using the Larg and Moss checklist. RESULTS This review included 44 studies. All studies were conducted in high-income countries and were limited to North America and Europe except for four studies: two in Asia and two in Australia. Most studies were retrospective and undertook a prevalence-based study design. Analysis revealed a substantial economic impact associated with ADHD. Estimates based on total costs ranged from $US831.38 to 20,538 for per person estimates and from $US356 million to 20.27 billion for national estimates. Estimates based on marginal costs ranged from $US244.15 to 18,751.00 for per person estimates and from $US12.18 million to 141.33 billion for national estimates. Studies that calculated economic burden across multiple domains of direct, indirect, and education and justice system costs for both children and adults with ADHD reported higher costs and translated gross domestic product than did studies that captured only a single domain or age group. CONCLUSIONS Despite the wide variation in methodologies in studies reviewed, the literature suggests that ADHD imposes a substantial economic burden on society. There is a dire need for cost-of-illness research in low- and middle-income countries to better inform the treatment and management of ADHD in these countries. In addition, guidelines on the conduct and reporting of economic burden studies are needed as they may improve standardisation of cost-of-illness studies.
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Affiliation(s)
- Anindit Chhibber
- Department of Pharmacotherapy, School of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | | | | | - Sajesh K Veettil
- Department of Pharmacotherapy, School of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, School of Pharmacy, University of Utah, Salt Lake City, UT, USA.
- School of Pharmacy, Monash University, Subang Jaya, Malaysia.
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Shi Y, Hunter Guevara LR, Dykhoff HJ, Sangaralingham LR, Phelan S, Zaccariello MJ, Warner DO. Racial Disparities in Diagnosis of Attention-Deficit/Hyperactivity Disorder in a US National Birth Cohort. JAMA Netw Open 2021; 4:e210321. [PMID: 33646315 PMCID: PMC7921900 DOI: 10.1001/jamanetworkopen.2021.0321] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE There are limited data on the racial disparities in the incidence of attention-deficit/hyperactivity disorder (ADHD) diagnosis in children at the national level. OBJECTIVE To explore differences in rates of diagnosis of ADHD and use of treatment among children by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed insurance claims data of children born in the US between January 1, 2006, and December 31, 2012, who had continuous insurance coverage for at least 4 years. The last date of follow-up included in the cohort was June 30, 2019. Race/ethnicity designations were based on self-report and included non-Hispanic White, Black, Hispanic, and Asian. Data were analyzed between October 2019 and December 2020. EXPOSURES Race and ethnicity. MAIN OUTCOMES AND MEASURES ADHD diagnosis as defined by International Classification of Diseases codes (ninth or tenth editions) and treatment within 1 year of diagnosis, including medication and behavior therapy as defined by billing codes. Data on ADHD diagnosis and treatment were adjusted for sex, region, and household income in a multivariate Cox regression model. RESULTS Among 238 011 children in the cohort (116 093 [48.8%] girls; 15 183 [6.7%] Asian, 14 792 [6.2%] Black, 23 358 [9.8%] Hispanic, and 173 082 [72.7%] White children), 11 401 (4.8%) were diagnosed with ADHD. The cumulative incidence at age 12 was 13.12% (95% CI, 12.79%-13.46%). In multivariate Cox regression adjusting for sex, region, and household income, the hazard ratio for Asian children was 0.48 (95% CI, 0.43-0.53); Black children, 0.83 (95% CI, 0.77-0.90); and Hispanic children, 0.77 (95% CI, 0.72, 0.82) compared with White children. In the first year after diagnosis, 516 preschool children (19.4%) received behavioral therapy only, 860 (32.4%) had medications only, 505 (19.0%) had both, and 774 (29.2%) had no claims associated with either option. A higher percentage of school-aged children (2904 [65.6%]) were prescribed medications, and fewer had therapy only (639 [14.4%]) or no treatment at all (884 [20.0%]). Compared with other groups, White children were more likely to receive some kind of treatment. Asian children had the highest odds of receiving no treatment (odds ratio compared with White children, 0.54; 95% CI, 0.42-0.70). CONCLUSIONS AND RELEVANCE Racial and ethnic disparities in the diagnosis and treatment of ADHD are evident. Future study is needed to elucidate the mechanism behind these disparities, with special attention to Asian children. Clinicians should provide racially sensitive care in the evaluation and treatment of ADHD.
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Affiliation(s)
- Yu Shi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Hayley J. Dykhoff
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Lindsey R. Sangaralingham
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- OptumLabs, Cambridge, Massachusetts
| | - Sean Phelan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - David O. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Shi Y, Schulte PJ, Hanson AC, Zaccariello MJ, Hu D, Crow S, Flick RP, Warner DO. Utility of medical record diagnostic codes to ascertain attention-deficit/hyperactivity disorder and learning disabilities in populations of children. BMC Pediatr 2020; 20:510. [PMID: 33158434 PMCID: PMC7648408 DOI: 10.1186/s12887-020-02411-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/31/2020] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND To develop and evaluate machine learning algorithms to ascertain attention-deficit/hyperactivity (ADHD) and learning disability (LD) using diagnostic codes in the medical record. METHOD Diagnoses of ADHD and LD were confirmed in cohorts of children in Olmsted County of Minnesota based on validated research criteria. Models to predict ADHD and LD were developed using ICD-9 codes in a derivation cohort of 1057 children before evaluated in a validation cohort of 536 children. RESULTS The ENET-MIN model using selected ICD-9 codes at prior probability of 0.25 has a sensitivity of 0.76, PPV of 0.85, specificity of 0.98, and NPV of 0.97 in the validation cohort. However, it does not offer significant advantage over a model using a single ICD-9 code of 314.X, which shows sensitivity of 0.81, PPV of 0.83, specificity of 0.98, and NPV of 0.97. None of the models developed for LD performed well in the validation cohort. CONCLUSIONS It is feasible to utilize diagnostic codes to ascertain cases of ADHD in a population of children. Machine learning approaches do not have advantage compared with simply using a single family of diagnostic codes for ADHD. The use of medical record diagnostic codes is not feasible to ascertain LD.
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Affiliation(s)
- Yu Shi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | | | - Andrew C Hanson
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | | | - Danqing Hu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Sheri Crow
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, USA
| | - Randall P Flick
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
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Engelhard MM, Berchuck SI, Garg J, Henao R, Olson A, Rusincovitch S, Dawson G, Kollins SH. Health system utilization before age 1 among children later diagnosed with autism or ADHD. Sci Rep 2020; 10:17677. [PMID: 33077796 PMCID: PMC7572401 DOI: 10.1038/s41598-020-74458-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/28/2020] [Indexed: 01/02/2023] Open
Abstract
Children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) have 2-3 times increased healthcare utilization and annual costs once diagnosed, but little is known about their utilization patterns early in life. Quantifying their early health system utilization could uncover condition-specific health trajectories to facilitate earlier detection and intervention. Patients born 10/1/2006-10/1/2016 with ≥ 2 well-child visits within the Duke University Health System before age 1 were grouped as ASD, ADHD, ASD + ADHD, or No Diagnosis using retrospective billing codes. An additional comparison group was defined by later upper respiratory infection diagnosis. Adjusted odds ratios (AOR) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression models. Length of hospital encounters were compared between groups via Mann-Whitney U test. In total, 29,929 patients met study criteria (ASD N = 343; ADHD N = 1175; ASD + ADHD N = 140). ASD was associated with increased procedures (AOR = 1.5, p < 0.001), including intubation and ventilation (AOR = 2.4, p < 0.001); and outpatient specialty care, including physical therapy (AOR = 3.5, p < 0.001) and ophthalmology (AOR = 3.1, p < 0.001). ADHD was associated with increased procedures (AOR = 1.41, p < 0.001), including blood transfusion (AOR = 4.7, p < 0.001); hospital admission (AOR = 1.60, p < 0.001); and ED visits (AOR = 1.58, p < 0.001). Median length of stay was increased after birth in ASD (+ 6.5 h, p < 0.001) and ADHD (+ 3.8 h, p < 0.001), and after non-birth admission in ADHD (+ 1.1 d, p < 0.001) and ASD + ADHD (+ 2.4 d, p = 0.003). Each condition was associated with increased health system utilization and distinctive patterns of utilization before age 1. Recognizing these patterns may contribute to earlier detection and intervention.
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Affiliation(s)
- Matthew M Engelhard
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Rd, Durham, NC, 27705, USA.
| | - Samuel I Berchuck
- Department of Statistical Science, Duke University, Durham, NC, USA
- Duke Forge, Duke University School of Medicine, Durham, NC, USA
| | - Jyotsna Garg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ricardo Henao
- Duke Forge, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Olson
- Duke Forge, Duke University School of Medicine, Durham, NC, USA
| | | | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Rd, Durham, NC, 27705, USA
- Duke Center for Autism and Brain Development and Duke Institute for Brain Sciences, Durham, NC, USA
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Rd, Durham, NC, 27705, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Nfonoyim B, Griffis H, Guevara J. Disparities in Childhood Attention Deficit Hyperactivity Disorder Symptom Severity by Neighborhood Poverty. Acad Pediatr 2020; 20:917-925. [PMID: 32081765 DOI: 10.1016/j.acap.2020.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the association between neighborhood poverty and Attention Deficit Hyperactivity Disorder (ADHD) severity among children in a large metropolitan area. METHODS This is a secondary analysis of data collected April 2016 to July 2017 at the Children's Hospital of Philadelphia Care Network. We attributed 2015 American Community Survey census tract poverty, defined as percent of individuals with income below poverty level, to each child's residential address. Tracts were grouped from low to high poverty. ADHD severity was determined by Vanderbilt Parent Rating Scale (VPRS) symptom score. We also recorded parent-reported child ADHD medication use. RESULTS A total of 286 children were linked to 203 unique census tracts. The majority of children from high poverty tracts were black and from disadvantaged households. Higher neighborhood poverty was associated with higher VPRS scores and decreased medication use in bivariate analysis. Poverty was no longer associated with VPRS scores in multivariate analysis, but medication use still had a significant negative association with VPRS score. Post hoc stratification by medication use revealed that neighborhood poverty and VPRS score were significantly associated for children on medication, but not for those off medication. CONCLUSIONS Neighborhood poverty was not associated with ADHD severity in multivariate analysis. This suggests other factors, including medication use, confound the relationship between neighborhood poverty and ADHD severity. Lack of medication treatment was significantly associated with higher symptom burdens for children with access to primary care. Decreased medication use in higher poverty communities warrants exploration and public health interventions to ensure adequate ADHD management for all children.
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Affiliation(s)
- Bianca Nfonoyim
- Perelman School of Medicine, University of Pennsylvania (B Nfonoyim and J Guevara), Philadelphia, Pa; PolicyLab, The Children's Hospital of Philadelphia (B Nfonoyim, H Griffis, and J Guevara), Philadelphia, Pa.
| | - Heather Griffis
- PolicyLab, The Children's Hospital of Philadelphia (B Nfonoyim, H Griffis, and J Guevara), Philadelphia, Pa
| | - James Guevara
- Perelman School of Medicine, University of Pennsylvania (B Nfonoyim and J Guevara), Philadelphia, Pa; PolicyLab, The Children's Hospital of Philadelphia (B Nfonoyim, H Griffis, and J Guevara), Philadelphia, Pa; Department of Pediatrics, The Children's Hospital of Philadelphia (J Guevara), Philadelphia, Pa
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15
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Du Rietz E, Jangmo A, Kuja-Halkola R, Chang Z, D'Onofrio BM, Ahnemark E, Werner-Kiechle T, Larsson H. 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; 61:959-968. [PMID: 32115717 DOI: 10.1111/jcpp.13206] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND A better understanding of the trajectories and economic burden of psychiatric and somatic disorders (multimorbidity) in ADHD from childhood to adulthood is important for guiding more targeted areas for treatment of ADHD and prevention of multimorbidity, and for forecasting demands on the medical infrastructure. This study aimed to investigate patterns of healthcare utilization and costs of multimorbidity across young adulthood in individuals with a childhood ADHD diagnosis, and additionally in individuals who continue to have ADHD-related contact with health services (persisters) and those who do not (remitters). METHODS We prospectively followed a cohort (N = 445,790) born 1987-1990 from the ages of 18 to 26 years. Data on healthcare utilization were obtained from the Swedish National Patient Register (inpatient and outpatient care) and the Prescribed Drug Register (medication prescriptions). RESULTS Mean annual costs per capita from multimorbidity was €890 ($1,223) in individuals with a childhood ADHD diagnosis (persisters/remitters: €1,060[$1,456]/€609[$837]) and €304 ($418) in individuals without. Costs were largely driven by inpatient hospital admissions, mainly from drug abuse and injuries. Healthcare utilization and costs of psychiatric and somatic disorders at 18 years was significantly higher in individuals with childhood ADHD compared to those without. These group differences remained stable or increased across young adulthood for most outcomes and were generally larger in women than in men. ADHD remitters continued to show significantly greater healthcare utilization and costs compared to individuals without childhood ADHD, although their profiles were not as severe as ADHD persisters. CONCLUSIONS Childhood ADHD has long-term associations with both psychiatric and somatic disorders. Findings demonstrate the individual and societal burden of ADHD in adulthood and highlight the importance of continued support from childhood-adolescent to adult health services and early prevention of multimorbidity. Findings also point to specific targets for intervention that may be effective, such as drug abuse and injuries.
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Affiliation(s)
- Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Andreas Jangmo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Ewa Ahnemark
- Shire Sweden AB, a Takeda Company, Stockholm, Sweden
| | | | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
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16
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Hong M, Park B, Lee SM, Bahn GH, Kim MJ, Park S, Oh IH, Park H. Economic Burden and Disability-Adjusted Life Years (DALYs) of Attention Deficit/Hyperactivity Disorder. J Atten Disord 2020; 24:823-829. [PMID: 31364445 DOI: 10.1177/1087054719864632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We investigated the economic burden and disability-adjusted life years (DALYs) for attention deficit/hyperactivity disorder (ADHD) in the Republic of Korea. Method: Using the National Health Insurance Service claims data for the population aged 19 years or younger, a prevalence-based approach was used to calculate the DALYs of ADHD. Direct medical costs, direct nonmedical costs, and indirect costs resulting from ADHD were estimated to calculate the economic burden of ADHD. Results: A total of 69,353 people in Korea were diagnosed with ADHD in 2012. The burden of ADHD as measured by the prevalence-based approach was 32,605 DALYs. The total economic burden of ADHD was US$47.55 million, which accounted for approximately 0.004% of Korean GDP (gross domestic product) in 2012. Conclusion: Our findings shed light on the considerable burden of ADHD, emphasizing the need for policies that can encourage ADHD treatment and enhance compliance.
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Affiliation(s)
- Minha Hong
- Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Bomi Park
- Ewha Womans University, Seoul, Korea
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17
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Gruschow SM, Yerys BE, Power TJ, Durbin DR, Curry AE. Validation of the Use of Electronic Health Records for Classification of ADHD Status. J Atten Disord 2019; 23:1647-1655. [PMID: 28112025 PMCID: PMC5843549 DOI: 10.1177/1087054716672337] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To validate an electronic health record (EHR)-based algorithm to classify ADHD status of pediatric patients. METHOD As part of an applied study, we identified all primary care patients of The Children's Hospital of Philadelphia [CHOP] health care network who were born 1987-1995 and residents of New Jersey. Patients were classified with ADHD if their EHR indicated an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of "314.x" at a clinical visit or on a list of known conditions. We manually reviewed EHRs for ADHD patients ( n = 2,030) and a random weighted sample of non-ADHD patients ( n = 807 of 13,579) to confirm the presence or absence of ADHD. RESULTS Depending on assumptions for inconclusive cases, sensitivity ranged from 0.96 to 0.97 (95% confidence interval [CI] = [0.95, 0.97]), specificity from 0.98 to 0.99 [0.97, 0.99], and positive predictive value from 0.83 to 0.98 [0.81, 0.99]. CONCLUSION EHR-based diagnostic codes can accurately classify ADHD status among pediatric patients and can be used by large-scale epidemiologic and clinical studies with high sensitivity and specificity.
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Affiliation(s)
| | - Benjamin E Yerys
- 1 The Children's Hospital of Philadelphia, PA, USA
- 2 University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Power
- 1 The Children's Hospital of Philadelphia, PA, USA
- 2 University of Pennsylvania, Philadelphia, PA, USA
| | - Dennis R Durbin
- 1 The Children's Hospital of Philadelphia, PA, USA
- 2 University of Pennsylvania, Philadelphia, PA, USA
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18
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Becker SP, Schindler DN, Holdaway AS, Tamm L, Epstein JN, Luebbe AM. The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019; 41:93-106. [PMID: 30930533 PMCID: PMC6438181 DOI: 10.1007/s10862-018-9702-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Co-occurring internalizing symptoms are common and important to assess in children with attention-deficit/hyperactivity disorder (ADHD). One frequently used child self-report measure of internalizing symptoms is the Revised Child Anxiety and Depression Scales (RCADS), yet the psychometric properties of the RCADS remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS in 117 children (ages 8-12; 66% male) evaluated for suspected ADHD at an ADHD specialty clinic (83% met criteria for ADHD). In addition to the RCADS, children completed measures of social anxiety and depression. Parents completed the RCADS-Parent Version (RCADS-P) in addition to other measures of internalizing and externalizing symptoms. Children and parents both completed a measure of aggression. Factor structure, reliability, and convergent/discriminant validity of the RCADS were examined. Results supported the six-factor structure of the child-report RCADS (Separation Anxiety, Social Phobia, Generalized Anxiety Disorder, Panic Disorder, and Obsessive Compulsive Disorder, Major Depressive Disorder). The RCADS demonstrated adequate reliability as well as convergent and discriminant validity with other child ratings. The total anxiety score on the RCADS also demonstrated convergent and discriminant validity with parent measures, though the depression score on the RCADS did not. Findings provide preliminary psychometric support for the RCADS in children referred for ADHD.
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Affiliation(s)
- Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dana N. Schindler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alex S. Holdaway
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Aaron M. Luebbe
- Department of Psychology, Miami University, Oxford, Ohio, USA
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Guo L, Danielson M, Cogan L, Hines L, Armour B. Treatment Patterns and Costs Among Children Aged 2 to 17 Years With ADHD in New York State Medicaid in 2013. J Atten Disord 2018; 25:463-472. [PMID: 30547693 PMCID: PMC6570581 DOI: 10.1177/1087054718816176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To identify children with ADHD enrolled in New York State (NYS) Medicaid and characterize ADHD-associated costs by treatment category. Method: In 2013, 1.4 million children aged 2 to 17 years were enrolled in NYS Medicaid. Medicaid claims and encounters were used to identify children with ADHD, classify them by type of treatment received, and estimate associated costs. Results: The ADHD cohort comprised 5.4% of all Medicaid-enrolled children, with 35.0% receiving medication only, 16.2% receiving psychological services only, 42.2% receiving both, and 6.6% receiving neither. The total costs for the ADHD cohort (US$729.3 million) accounted for 18.1% of the total costs for children enrolled in NYS Medicaid. Conclusion: This study underscores the importance of achieving a better understanding of children with ADHD enrolled in NYS Medicaid. A framework to categorize children with ADHD based on their treatment categories may help to target interventions to improve the quality of care and reduce costs.
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Affiliation(s)
- Liqiong Guo
- New York State Department of Health, Albany, NY, USA
| | | | - Lindsay Cogan
- New York State Department of Health, Albany, NY, USA
| | - Leah Hines
- New York State Department of Health, Albany, NY, USA
| | - Brian Armour
- Centers for Disease Control and Prevention, Atlanta, GA,
USA
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20
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Outpatient rehabilitation resources and medical expenditure in children with attention-deficit hyperactivity disorder in Taiwan. PLoS One 2018; 13:e0199877. [PMID: 29953532 PMCID: PMC6023132 DOI: 10.1371/journal.pone.0199877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 06/15/2018] [Indexed: 11/19/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in children. This study investigated the use of rehabilitation treatment in Taiwan. We selected children aged 3-12 years from the National Health Insurance Research Database from 2008 to 2012 and included them in the analysis. The children who received a diagnosis according to the International Classification of Diseases, Ninth Revision, Clinical Modification were divided into two groups: ADHD and non-ADHD. We used the chi-squared test, independent sample t test, and multiple regression analysis to conduct the analysis. The utilisation of rehabilitation resources was higher in the ADHD group than in the non-ADHD group. The number of school-aged children with ADHD was higher than the number of preschool-aged children (p < 0.001). The highest utilisation of rehabilitation resources was observed in clinics (p < 0.001). In terms of region, Taipei exhibited the highest utilisation of rehabilitation resources, and the East exhibited the lowest resource utilisation (p < 0.001). Prediction of the use of rehabilitation resources, average cost, average frequency of visits, and total annual cost was affected by factors such as the average frequency of rehabilitation use, demographic characteristics, and the hospital characteristics and location (p < 0.001). The number of children with ADHD and rehabilitation use are increasing yearly; however, limitations in payment restrict the growth of rehabilitation resource use in hospitals. Supplementation of rehabilitation resources at clinics accounts for more than 60%, however, the total annual cost is less than what is observed for hospitals (p < 0.001). Policies should be established to aid in the early detection and treatment of children with ADHD to improve treatment outcomes and reduce the family burden and treatment expenditure in the future.
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Mendelsohn AL, Cates CB, Weisleder A, Berkule Johnson S, Seery AM, Canfield CF, Huberman HS, Dreyer BP. Reading Aloud, Play, and Social-Emotional Development. Pediatrics 2018; 141:peds.2017-3393. [PMID: 29632254 PMCID: PMC5914489 DOI: 10.1542/peds.2017-3393] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine impacts on social-emotional development at school entry of a pediatric primary care intervention (Video Interaction Project [VIP]) promoting positive parenting through reading aloud and play, delivered in 2 phases: infant through toddler (VIP birth to 3 years [VIP 0-3]) and preschool-age (VIP 3 to 5 years [VIP 3-5]). METHODS Factorial randomized controlled trial with postpartum enrollment and random assignment to VIP 0-3, control 0 to 3 years, and a third group without school entry follow-up (Building Blocks) and 3-year second random assignment of VIP 0-3 and control 0 to 3 years to VIP 3-5 or control 3 to 5 years. In the VIP, a bilingual facilitator video recorded the parent and child reading and/or playing using provided learning materials and reviewed videos to reinforce positive interactions. Social-emotional development at 4.5 years was assessed by parent-report Behavior Assessment System for Children, Second Edition (Social Skills, Attention Problems, Hyperactivity, Aggression, Externalizing Problems). RESULTS VIP 0-3 and VIP 3-5 were independently associated with improved 4.5-year Behavior Assessment System for Children, Second Edition T-scores, with effect sizes (Cohen's d) ∼-0.25 to -0.30. Receipt of combined VIP 0-3 and VIP 3-5 was associated with d = -0.63 reduction in Hyperactivity (P = .001). VIP 0-3 resulted in reduced "Clinically Significant" Hyperactivity (relative risk reduction for overall sample: 69.2%; P = .03; relative risk reduction for increased psychosocial risk: 100%; P = .006). Multilevel models revealed significant VIP 0-3 linear effects and age × VIP 3-5 interactions. CONCLUSIONS Phase VIP 0-3 resulted in sustained impacts on behavior problems 1.5 years after program completion. VIP 3-5 had additional, independent impacts. With our findings, we support the use of pediatric primary care to promote reading aloud and play from birth to 5 years, and the potential for such programs to enhance social-emotional development.
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Affiliation(s)
- Alan L. Mendelsohn
- Department of Pediatrics, School of Medicine, New York University and Bellevue Hospital Center, New York, New York
| | - Carolyn Brockmeyer Cates
- Department of Pediatrics, School of Medicine, New York University and Bellevue Hospital Center, New York, New York
| | - Adriana Weisleder
- Department of Pediatrics, School of Medicine, New York University and Bellevue Hospital Center, New York, New York;,Department of Communication Sciences and Disorders, Northwestern University, Chicago, Illinois; and
| | - Samantha Berkule Johnson
- Department of Pediatrics, School of Medicine, New York University and Bellevue Hospital Center, New York, New York
| | - Anne M. Seery
- Department of Pediatrics, School of Medicine, New York University and Bellevue Hospital Center, New York, New York
| | - Caitlin F. Canfield
- Department of Pediatrics, School of Medicine, New York University and Bellevue Hospital Center, New York, New York
| | - Harris S. Huberman
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Benard P. Dreyer
- Department of Pediatrics, School of Medicine, New York University and Bellevue Hospital Center, New York, New York
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Molife C, Haynes VS, Nyhuis A, Faries DE, Gelwicks S, Kelsey DK, Alatorre CI. Healthcare utilization and costs of children with attention deficit/hyperactivity disorder initiating atomoxetine versus extended-release guanfacine. Curr Med Res Opin 2018; 34:619-632. [PMID: 29298540 DOI: 10.1080/03007995.2017.1421918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare 1-year direct healthcare costs and utilization among children and adolescents initiating non-stimulant medications atomoxetine (ATX) or extended-release guanfacine (GXR). METHODS In this retrospective, observational cohort study, children and adolescents aged 6-17 years with attention deficit/hyperactivity disorder (ADHD) who had ≥1 prescription claim for ATX or GXR between December 31, 2009 and January 1, 2011 were identified in the MarketScan Commercial or Multi-State Medicaid claims databases. The first claim was set as the index. Patients with no claims for other ADHD medications that overlapped with the days' supply for the index therapy during the post-period were classified as initiating monotherapy. All-cause and ADHD-related utilization and costs (2011 US$) and treatment patterns (adherence and persistence) were evaluated during the 12 months following index. Propensity score adjustment accounted for differences in patient characteristics, and bootstrapping was used for comparisons. RESULTS A total of 13,239 children and adolescents with ADHD met the study criteria (4,411 ATX initiators and 8,828 GXR initiators). There were 2,699 ATX monotherapy patients. In propensity-score-adjusted analyses, mean all-cause total costs were significantly less for monotherapy ATX initiators than for GXR initiators ($7,553 vs $10,639; difference = -$3,086, p < .0001), as were mean ADHD-related total costs ($3,213 vs $4,544; difference = -$1,330, p < .0001). Monotherapy ATX initiators had significantly fewer all-cause and ADHD-related total medical visits and ∼22 days shorter persistence to index therapy (p < .0001). Results were similar for secondary analyses comparing all ATX with all GXR initiators, regardless of monotherapy or combination regimen, and comparing only monotherapy initiators. CONCLUSIONS Children and adolescents with ADHD who initiated ATX monotherapy incurred lower all-cause and ADHD-related total healthcare costs than patients who initiated GXR. This was due in part to less healthcare resource utilization and slightly shorter persistence for ATX patients. These findings may aid decision-making and inform future studies, but must be tempered due to inherent observational research limitations.
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Affiliation(s)
- Cliff Molife
- a Eli Lilly and Company - Global Patient Outcomes and Real World Evidence , Lilly Corporate Center , Indianapolis , IN , USA
| | - Virginia S Haynes
- b Eli Lilly and Company - Health Outcomes , Lilly Corporate Center , Indianapolis , IN , USA
| | - Allen Nyhuis
- c Eli Lilly and Company , Lilly Corporate Center , Indianapolis , IN , USA
| | - Douglas E Faries
- b Eli Lilly and Company - Health Outcomes , Lilly Corporate Center , Indianapolis , IN , USA
| | - Steve Gelwicks
- b Eli Lilly and Company - Health Outcomes , Lilly Corporate Center , Indianapolis , IN , USA
| | | | - Carlos I Alatorre
- b Eli Lilly and Company - Health Outcomes , Lilly Corporate Center , Indianapolis , IN , USA
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23
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Sciberras E, Lucas N, Efron D, Gold L, Hiscock H, Nicholson JM. Health Care Costs Associated With Parent-Reported ADHD: A Longitudinal Australian Population-Based Study. J Atten Disord 2017; 21:1063-1072. [PMID: 23816972 DOI: 10.1177/1087054713491494] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the health care costs associated with ADHD within a nationally representative sample of children. METHOD Data were from Waves 1 to 3 (4-9 years) of the Longitudinal Study of Australian Children ( N = 4,983). ADHD was defined by previous diagnosis and a measure of ADHD symptoms (Strengths and Difficulties Questionnaire [SDQ]). Participant data were linked to administrative data on health care costs. Analyses controlled for demographic factors and internalizing and externalizing comorbidities. RESULTS Costs associated with health care attendances and medications were higher for children with parent-reported ADHD at each age. Cost differences were highest at 8 to 9 years for both health care attendances and medications. Persistent symptoms were associated with higher costs ( p < .001). Excess population health care costs amounted to Aus$25 to Aus$30 million over 6 years, from 4 to 9 years of age. CONCLUSION ADHD is associated with significant health care costs from early in life. Understanding the costs associated with ADHD is an important first step in helping to plan for service-system changes.
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Affiliation(s)
- Emma Sciberras
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 The Royal Children's Hospital, Melbourne, Australia
| | - Nina Lucas
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,3 Australian National University, Canberra, Australia.,4 Parenting Research Centre, Melbourne, Australia
| | - Daryl Efron
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 The Royal Children's Hospital, Melbourne, Australia.,5 University of Melbourne, Australia
| | - Lisa Gold
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,6 Deakin University, Melbourne, Australia
| | - Harriet Hiscock
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,2 The Royal Children's Hospital, Melbourne, Australia.,5 University of Melbourne, Australia
| | - Jan M Nicholson
- 1 Murdoch Childrens Research Institute, Melbourne, Australia.,4 Parenting Research Centre, Melbourne, Australia
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24
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Becker SP, Schindler DN, Luebbe AM, Tamm L, Epstein JN. Psychometric Validation of the Revised Child Anxiety and Depression Scales-Parent Version (RCADS-P) in Children Evaluated for ADHD. Assessment 2017; 26:811-824. [PMID: 29029564 DOI: 10.1177/1073191117735886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience comorbid internalizing symptoms. The Revised Child Anxiety and Depression Scales-Parent Version (RCADS-P) is a frequently used measure of anxiety and depression in children, though its psychometric properties remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS-P in 372 children (age 7-12 years; 68% male) referred for evaluation at an ADHD specialty clinic (89% met criteria for ADHD). In addition to the RCADS-P, parents completed the Vanderbilt ADHD Diagnostic Rating Scale and Child Behavior Checklist and were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children semistructured diagnostic interview. Teacher ratings were available for approximately half of the sample. Factor structure, reliability, convergent/discriminant validity, and sensitivity/specificity were examined. Results supported the six-factor structure of the RCADS-P. The RCADS-P demonstrated adequate internal consistency as well as convergent and discriminant validity with other parent ratings and, to a somewhat lesser extent, teacher ratings. Children with an internalizing diagnosis had higher RCADS-P scores than children without an internalizing diagnosis. Finally, the RCADS-P had good-to-excellent diagnostic efficiency, and a total sum score of 25 had excellent sensitivity and fair specificity. Findings provide psychometric support for the RCADS-P in children with ADHD.
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Affiliation(s)
- Stephen P Becker
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dana N Schindler
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Leanne Tamm
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffery N Epstein
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 University of Cincinnati College of Medicine, Cincinnati, OH, USA
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25
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Fleming M, Fitton CA, Steiner MFC, McLay JS, Clark D, King A, Mackay DF, Pell JP. Educational and Health Outcomes of Children Treated for Attention-Deficit/Hyperactivity Disorder. JAMA Pediatr 2017; 171:e170691. [PMID: 28459927 PMCID: PMC6583483 DOI: 10.1001/jamapediatrics.2017.0691] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) affects 39 million people worldwide; in isolation, it doubles annual health care costs and, when associated with comorbid mental health problems, it quadruples the costs. OBJECTIVE To compare the education and health outcomes of schoolchildren treated for ADHD with their peers. DESIGN, SETTING, AND PARTICIPANTS In this population-based cohort study, individual-level record linkage was performed of 8 Scotland-wide administrative databases covering dispensed prescriptions, admissions to acute and psychiatric hospitals, maternity records, annual pupil census, examinations, school absences and exclusions, and unemployment. The study cohort comprised 766 244 children attending Scottish primary, secondary, and special schools at any point between September 21, 2009, and September 18, 2013. Data analysis was performed from June 1, 2015, to December 6, 2016. EXPOSURES Medication approved solely for ADHD treatment. MAIN OUTCOMES AND MEASURES Special educational needs, academic attainment, unauthorized absence, exclusion, age at leaving school, unemployment after leaving, and hospitalization. Outcomes were adjusted for potential sociodemographic, maternity, and comorbidity confounders. RESULTS Of the 766 244 schoolchildren, 7413 (1.0%) were treated for ADHD; 6287 (84.8%) were male. These children had higher rates of unauthorized absence (adjusted incidence rate ratio [IRR], 1.16; 95% CI, 1.14-1.19) and exclusion (adjusted IRR, 5.79; 95% CI, 5.45-6.16), more commonly had a record of special educational need (adjusted odds ratio [OR], 8.62; 95% CI, 8.26-9.00), achieved lower academic attainment (adjusted OR, 3.35; 95% CI, 3.00-3.75), were more likely to leave school before age 16 years (1546 [64.3%] vs 61 235 [28.4%]), and were more likely to be unemployed (adjusted OR, 1.39; 95% CI, 1.25-1.53). Children with ADHD were more likely to require hospitalization overall (adjusted hazard ratio [HR], 1.25; 95% CI, 1.19-1.31) and for injury (adjusted HR, 1.52; 95% CI, 1.40-1.65). CONCLUSIONS AND RELEVANCE Even while receiving medication, children with ADHD fare worse than their peers across a wide range of outcomes relating not only to education but also to health.
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Affiliation(s)
- Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | | | | | - James S. McLay
- Department of Child Health, University of Aberdeen, Aberdeen, Scotland
| | - David Clark
- Information Services Division, Edinburgh, Scotland
| | - Albert King
- ScotXed, Scottish Government, Edinburgh, Scotland
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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26
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Walter AW, Yuan Y, Cabral HJ. Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans. Pediatrics 2017; 139:S127-S135. [PMID: 28562310 DOI: 10.1542/peds.2016-2786g] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services. METHODS Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007-2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used. RESULTS Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010-2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs. CONCLUSIONS Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans.
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Affiliation(s)
- Angela Wangari Walter
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts;
| | - Yiyang Yuan
- Center for Advancing Health Policy and Practice, and
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; and.,Clinical and Translational Science Institute, Boston University, Boston, Massachusetts
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27
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Casadei G, Cartabia M, Reale L, Costantino MA, Bonati M. Italian regional health service costs for diagnosis and 1-year treatment of ADHD in children and adolescents. Int J Ment Health Syst 2017; 11:33. [PMID: 28465719 PMCID: PMC5410029 DOI: 10.1186/s13033-017-0140-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/12/2017] [Indexed: 11/10/2022] Open
Abstract
The main aim of this study was to estimate the costs associated with diagnostic assessment and 1-year therapy in children and adolescents enrolled in 18 ADHD reference centres. Data concerning 1887 children and adolescents from the mandatory ADHD registry database during the 2012–2014 period were analysed. The overall diagnostic and treatment costs per patient amounts to €574 and €830, respectively. The ADHD centre, the school as sender, and the time to diagnosis constitute cost drivers. Non-pharmacological therapy resulted as being more expensive for patients concomitantly treated with drugs (€929) compared to those treated with psychological interventions alone (€590; p = 0.006). This study gives the first and reliable estimate of the costs associated with both diagnosis and treatment of ADHD in Italy. Although costs associated with mental disorders are difficult to estimate, continuing efforts are need to define costs and resources to guarantee appropriate care, also for ADHD.
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Affiliation(s)
- Gianluigi Casadei
- CESAV-"Angelo e Angela Valenti" Centre for Health Economics, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - Massimo Cartabia
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Laura Reale
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Maria Antonella Costantino
- Child and Adolescent Neuropsychiatric Unit, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
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28
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Gupte-Singh K, Singh RR, Lawson KA. Economic Burden of Attention-Deficit/Hyperactivity Disorder among Pediatric Patients in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:602-609. [PMID: 28408002 DOI: 10.1016/j.jval.2017.01.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To determine the adjusted incremental total costs (direct and indirect) for patients (aged 3-17 years) with attention-deficit/hyperactivity disorder (ADHD) and the differences in the adjusted incremental direct expenditures with respect to age groups (preschoolers, 0-5 years; children, 6-11 years; and adolescents, 12-17 years). METHODS The 2011 Medical Expenditure Panel Survey was used as the data source. The ADHD cohort consisted of patients aged 0 to 17 years with a diagnosis of ADHD, whereas the non-ADHD cohort consisted of subjects in the same age range without a diagnosis of ADHD. The annual incremental total cost of ADHD is composed of the incremental direct expenditures and indirect costs. A two-part model with a logistic regression (first part) and a generalized linear model (second part) was used to estimate the incremental costs of ADHD while controlling for patient characteristics and access-to-care variables. RESULTS The 2011 Medical Expenditure Panel Survey database included 9108 individuals aged 0 to 17 years, with 458 (5.0%) having an ADHD diagnosis. The ADHD cohort was 4.90 times more likely (95% confidence interval [CI] 2.97-8.08; P < 0.001) than the non-ADHD cohort to have an expenditure of at least $1, and among those with positive expenditures, the ADHD cohort had 58.4% higher expenditures than the non-ADHD cohort (P < 0.001). The estimated adjusted annual total incremental cost of ADHD was $949.24 (95% CI $593.30-$1305.18; P < 0.001). The adjusted annual incremental total direct expenditure for ADHD was higher among preschoolers ($989.34; 95% CI $402.70-$1575.98; P = 0.001) than among adolescents ($894.94; 95% CI $428.16-$1361.71; P < 0.001) or children ($682.71; 95% CI $347.94-$1017.48; P < 0.001). CONCLUSIONS Early diagnosis and use of evidence-based treatments may address the substantial burden of ADHD.
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Affiliation(s)
- Komal Gupte-Singh
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
| | - Rakesh R Singh
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kenneth A Lawson
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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29
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Pulcini CD, Zima BT, Kelleher KJ, Houtrow AJ. Poverty and Trends in Three Common Chronic Disorders. Pediatrics 2017; 139:peds.2016-2539. [PMID: 28193790 DOI: 10.1542/peds.2016-2539] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions. METHODS Secondary analyses of the National Survey of Children's Health for years 2003, 2007, and 2011-2012 were conducted to identify trends in parent reported lifetime prevalence and comorbidity among children with asthma, ADHD, and ASD and examine variation by sociodemographic characteristics, poverty status, and insurance coverage. Using 2011-2012 data, multivariable regression was used to examine whether poverty status predicted higher than average comorbid conditions after adjusting for other sociodemographic characteristics. RESULTS Parent-reported lifetime prevalence of asthma and ADHD rose 18% and 44%, respectively, whereas the lifetime prevalence of ASD rose almost 400% (from 0.5% to 2%). For asthma, the rise was most prominent among the poor at 25.8%. For ADHD, the percent change by poverty status was similar (<100% federal poverty level [FPL]: 43.20%, 100% to 199% FPL: 52.38%, 200% to 399% FPL: 43.67%), although rise in ASD was associated with being nonpoor (200% to 399% FPL: 43.6%, ≥400% FPL: 36.0%). Publicly insured children with asthma, ADHD, and ASD also had significantly higher odds (1.9×, 1.6×, 3.0×, respectively) of having higher than average comorbidities. CONCLUSIONS Poverty status differentially influenced parent-reported lifetime prevalence and comorbidities of these target disorders. Future research is needed to examine parent and system-level characteristics that may further explain poverty's variable impact.
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Affiliation(s)
- Christian D Pulcini
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Bonnie T Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Kelly J Kelleher
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio; and
| | - Amy J Houtrow
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; .,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
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30
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Daley MF, Newton DA, DeBar L, Newcomer SR, Pieper L, Boscarino JA, Toh S, Pawloski P, Nordin JD, Nakasato C, Herrinton LJ, Bussing R. Accuracy of Electronic Health Record-Derived Data for the Identification of Incident ADHD. J Atten Disord 2017; 21:416-425. [PMID: 24510475 DOI: 10.1177/1087054713520616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the accuracy of electronic health record (EHR)-derived diagnoses in identifying children with incident (i.e., newly diagnosed) ADHD. METHOD In 10 large health care organizations, electronic diagnoses data were used to identify all potential cases of incident ADHD among 3- through 9-year-old children. A random sample of records was manually reviewed to determine whether a diagnosis of ADHD was documented in clinician notes. RESULTS From electronic diagnoses data, a total of 7,362 children with incident ADHD were identified. Upon manual review of 500 records, the diagnosis of incident ADHD was confirmed in clinician notes for 71.5% (95% confidence interval [CI] = [56.5, 86.4]) of records for 3- through 5-year-old children and 73.6% (95% CI = [65.6, 81.6]) of records for 6- through 9-year-old children. CONCLUSION Studies predicated on the identification of incident ADHD cases will need to carefully consider study designs that minimize the likelihood of case misclassification.
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Affiliation(s)
- Matthew F Daley
- 1 Kaiser Permanente Colorado, Denver, CO, USA.,2 University of Colorado, Aurora, CO, USA
| | | | - Lynn DeBar
- 3 Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Lisa Pieper
- 1 Kaiser Permanente Colorado, Denver, CO, USA
| | | | | | - Pamala Pawloski
- 6 HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - James D Nordin
- 6 HealthPartners Institute for Education and Research, Minneapolis, MN, USA
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31
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Bui AL, Dieleman JL, Hamavid H, Birger M, Chapin A, Duber HC, Horst C, Reynolds A, Squires E, Chung PJ, Murray CJL. Spending on Children's Personal Health Care in the United States, 1996-2013. JAMA Pediatr 2017; 171:181-189. [PMID: 28027344 PMCID: PMC5546095 DOI: 10.1001/jamapediatrics.2016.4086] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time. OBJECTIVE To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care. EVIDENCE REVIEW Health care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars. FINDINGS From 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1-155.5) billion to $233.5 (UI, 226.9-239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11 741 (UI, 10 799-12 765) in 2013. Across time, health care spending per child increased from $1915 (UI, 1845-1991) in 1996 to $2777 (UI, 2698-2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions. CONCLUSIONS AND RELEVANCE These findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions.
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Affiliation(s)
- Anthony L. Bui
- David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | | | - Hannah Hamavid
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Maxwell Birger
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Abigail Chapin
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Herbert C. Duber
- Institute for Health Metrics and Evaluation, Seattle, Washington3Division of Emergency Medicine, University of Washington, Seattle
| | - Cody Horst
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Alex Reynolds
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Ellen Squires
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Paul J. Chung
- Departments of Pediatrics and Health Policy and Management, University of California, Los Angeles5RAND Health, RAND Corporation, Santa Monica, California
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32
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Parent-Reported Health Consequences and Relationship to Expenditures in Children with ADHD. Matern Child Health J 2017; 20:915-24. [PMID: 26754346 DOI: 10.1007/s10995-015-1880-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES (1) To describe parents' report of special needs for children with ADHD on the Children with Special Health Care Needs (CSHCN) Screener; and (2) to assess the association between responses to Screener items and annual mental health and total health expenditures per child. METHODS In pooled 2002-2011 Medical Expenditure Panel Survey (MEPS) data, we identify children ages 4-17 years with ADHD. We use OLS and two-part regressions to model the relationship between CSHCN Screener items and mental health and total health expenditures. Based on these models we estimate adjusted, average total health expenditures for children with ADHD-both with and without a co-morbid mental health condition-and different combinations of endorsed Screener items. This research was conducted in accordance with prevailing ethical principles. RESULTS There were 3883 observations on 2591 children with ADHD. Without a co-morbid mental health condition, average total expenditures per year from adjusted, model-based estimates were $865 for those meeting no Screener items, $2664 for those meeting only the medication item, $3595 for those meeting the medication and counseling items, and $4203 for those meeting the medication, counseling, and use of more health services items. Children with a co-morbid mental health condition had greater total health expenditures for each combination of Screener items. The associations between Screener items and mental health expenditures were similar, but with a slightly lower marginal effect of the medication item (p < 0.001 for all comparisons). CONCLUSIONS Parents' responses on the CSHCN Screener are associated with meaningful variation in expenditures for children with ADHD. Though cross-sectional, this study suggests that the CSHCN Screener can be a useful categorization scheme for children with ADHD. It may be an efficient, standardized tool at the point of care for identifying children who need more resources and for targeting intensive interventions in the context of population health management.
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33
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Doupnik SK, Lawlor J, Zima BT, Coker TR, Bardach NS, Hall M, Berry JG. Mental Health Conditions and Medical and Surgical Hospital Utilization. Pediatrics 2016; 138:peds.2016-2416. [PMID: 27940716 PMCID: PMC5127076 DOI: 10.1542/peds.2016-2416] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Mental health conditions are prevalent among children hospitalized for medical conditions and surgical procedures, but little is known about their influence on hospital resource use. The objectives of this study were to examine how hospitalization characteristics vary by presence of a comorbid mental health condition and estimate the association of a comorbid mental health condition with hospital length of stay (LOS) and costs. METHODS Using the 2012 Kids' Inpatient Database, we conducted a retrospective, nationally representative, cross-sectional study of 670 161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. Associations between mental health conditions and hospital LOS were examined using adjusted generalized linear models. Costs of additional hospital days associated with mental health conditions were estimated using hospital cost-to-charge ratios. RESULTS A comorbid mental health condition was present in 13.2% of hospitalizations. A comorbid mental health condition was associated with a LOS increase of 8.8% (from 2.5 to 2.7 days, P < .001) for medical hospitalizations and a 16.9% increase (from 3.6 to 4.2 days, P < .001) for surgical hospitalizations. For hospitalizations in this sample, comorbid mental health conditions were associated with an additional 31 729 (95% confidence interval: 29 085 to 33 492) hospital days and $90 million (95% confidence interval: $81 to $101 million) in hospital costs. CONCLUSIONS Medical and surgical hospitalizations with comorbid mental health conditions were associated with longer hospital stay and higher hospital costs. Knowledge about the influence of mental health conditions on pediatric hospital utilization can inform clinical innovation and case-mix adjustment.
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Affiliation(s)
- Stephanie K. Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Lawlor
- Children’s Hospital Association, Washington, District of Columbia;,Children's Hospital Association, Overland Park, Kansas
| | - Bonnie T. Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Tumaini R. Coker
- Department of Pediatrics, UCLA Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Naomi S. Bardach
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, University of California at San Francisco, San Francisco, California; and
| | - Matt Hall
- Children’s Hospital Association, Washington, District of Columbia;,Children's Hospital Association, Overland Park, Kansas
| | - Jay G. Berry
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Zima BT, Rodean J, Hall M, Bardach NS, Coker TR, Berry JG. Psychiatric Disorders and Trends in Resource Use in Pediatric Hospitals. Pediatrics 2016; 138:peds.2016-0909. [PMID: 27940773 PMCID: PMC5079078 DOI: 10.1542/peds.2016-0909] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe recent, 10-year trends in pediatric hospital resource use with and without a psychiatric diagnosis and examine how these trends vary by type of psychiatric and medical diagnosis cooccurrence. METHODS A retrospective, longitudinal cohort analysis using hospital discharge data from 33 tertiary care US children's hospitals of patients ages 3 to 17 years from January 1, 2005 through December 31, 2014. The trends in hospital discharges, hospital days, and total aggregate costs for each psychiatric comorbid group were assessed by using multivariate generalized estimating equations. RESULTS From 2005 to 2014, the cumulative percent growth in resource use was significantly (all P < .001) greater for children hospitalized with versus without a psychiatric diagnosis (hospitalizations: +137.7% vs +26.0%; hospital days: +92.9% vs 5.9%; and costs: +142.7% vs + 18.9%). During this time period, the most substantial growth was observed in children admitted with a medical condition who also had a cooccurring psychiatric diagnosis (hospitalizations: +160.5%; hospital days: +112.4%; costs: +156.2%). In 2014, these children accounted for 77.8% of all hospitalizations for children with a psychiatric diagnosis; their most common psychiatric diagnoses were developmental disorders (22.3%), attention-deficit/hyperactivity disorder (18.1%), and anxiety disorders (14.2%). CONCLUSIONS The 10-year rise in pediatric hospitalizations in US children's hospitals is 5 times greater for children with versus without a psychiatric diagnosis. Strategic planning to meet the rising demand for psychiatric care in tertiary care children's hospitals should place high priority on the needs of children with a primary medical condition and cooccurring psychiatric disorders.
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Affiliation(s)
- Bonnie T. Zima
- Departments of Psychiatry and Biobehavioral Science, UCLA Semel Institute for Neuroscience and Human Behavior, and
| | | | - Matt Hall
- Children’s Hospital Association, Overland Park, Kansas
| | - Naomi S. Bardach
- Department of Pediatrics, UCSF School of Medicine, University of California, San Francisco, San Francisco, California; and
| | - Tumaini R. Coker
- General Pediatrics, UCLA Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Jay G. Berry
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Punja S, Nikles CJ, Senior H, Mitchell G, Schmid CH, Heussler H, Witmans M, Vohra S. Melatonin in Youth: N-of-1 trials in a stimulant-treated ADHD Population (MYNAP): study protocol for a randomized controlled trial. Trials 2016; 17:375. [PMID: 27473269 PMCID: PMC4966772 DOI: 10.1186/s13063-016-1499-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a common neurological disorder affecting 5 % of children worldwide. A prevalent problem for children with ADHD is initial insomnia. The gold standard treatment to manage ADHD symptoms is stimulant medications, which may exacerbate the severity of existing initial insomnia. Currently, no gold standard treatment option exists for initial insomnia for these children. Melatonin, a hormone and a popular natural health product, is commonly provided to children by parents and recommended by healthcare providers, but high quality pediatric evidence is lacking. METHODS/DESIGN This trial is a multicenter randomized triple-blind, placebo-controlled, parallel-group, randomized, controlled trial (RCT), in which each participant is offered an N-of-1 trial. An N-of-1 trial is a multiple-crossover, randomized, controlled trial conducted in a single individual. For the N-of-1 trial, each participant will undergo three pairs of treatment/placebo periods; each period is 1 week in length. Half the participants will have melatonin in the first period, the other half will start with placebo, and this will make up the parallel-group RCT. The primary outcome will be mean difference in sleep onset latency as measured by sleep diaries. A comparison of treatment effects yielded by the RCT data versus the aggregated N-of-1 trial data will also be assessed. DISCUSSION This trial will provide rigorous evidence for the effectiveness of melatonin in children with ADHD on stimulants who experience initial insomnia. Further, this study will provide the first prospectively planned head-to-head comparison of RCT data with pooled data from a series of N-of-1 trials. Aggregated N-of-1 trials may be a powerful tool to produce high quality clinical trial evidence. TRIAL REGISTRATION NUMBERS ClinicalTrials.gov, NCT02333149 . Registered on 16 December 2014. Australian New Zealand Clinical Trials Registry, ACTRN12614000542695 . Registered on 21 May 2014.
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Affiliation(s)
- Salima Punja
- Complementary and Alternative Research Education (CARE) Program, Department of Pediatrics, University of Alberta, #1702 College Plaza, 8512-112 Street NW, Edmonton, Alberta T6G 2C8 Canada
| | - Catherine J. Nikles
- Center for Clinical Research, The University of Queensland, Brisbane, Queensland Australia
| | - Hugh Senior
- College of Health, Massey University, Auckland, New Zealand
- Discipline of General Practice, The University of Queensland, Brisbane, Queensland Australia
| | - Geoffrey Mitchell
- Discipline of General Practice, The University of Queensland, Brisbane, Queensland Australia
| | - Christopher H. Schmid
- Department of Biostatistics and Center for Evidence Based Medicine, School of Public Health, Brown University, Providence, Rhode Island USA
| | | | | | - Sunita Vohra
- Complementary and Alternative Research Education (CARE) Program, Department of Pediatrics, University of Alberta, #1702 College Plaza, 8512-112 Street NW, Edmonton, Alberta T6G 2C8 Canada
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Linden S, Bussing R, Kubilis P, Gerhard T, Segal R, Shuster JJ, Winterstein AG. Risk of Suicidal Events With Atomoxetine Compared to Stimulant Treatment: A Cohort Study. Pediatrics 2016; 137:peds.2015-3199. [PMID: 27244795 PMCID: PMC4845870 DOI: 10.1542/peds.2015-3199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antidepressant effects on increased suicidality in children have raised public concern in recent years. Approved in 2002 for attention-deficit/hyperactivity disorder treatment, the selective noradrenalin-reuptake-inhibitor atomoxetine was initially investigated for the treatment of depression. In post-hoc analyses of clinical trial data, atomoxetine has been associated with an increased risk of suicidal ideation in children and adolescents. We analyzed whether the observed increased risk of suicidal ideation in clinical trials translates into an increased risk of suicidal events in pediatric patients treated with atomoxetine compared with stimulants in 26 Medicaid programs. METHODS Employing a retrospective cohort design, we used propensity score-adjusted Cox proportional hazard models to evaluate the risk of suicide and suicide attempt in pediatric patients initiating treatment with atomoxetine compared with stimulants from 2002 to 2006. RESULTS The first-line treatment cohort included 279 315 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.95 (95% CI 0.47-1.92, P = .88). The second-line treatment cohort included 220 215 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.71 (95% CI 0.30-1.67, P = .43). CONCLUSIONS First- and second-line treatment of youths age 5 to 18 with atomoxetine compared with stimulants was not significantly associated with an increased risk of suicidal events. The low incidence of suicide and suicide attempt resulted in wide confidence intervals and did not allow stratified analysis of high-risk groups or assessment of suicidal risk associated with long-term use of atomoxetine.
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Affiliation(s)
- Stephan Linden
- Pharmaceutical Outcomes and Policy, College of Pharmacy,
| | - Regina Bussing
- Departments of Psychiatry and Pediatrics, College of Medicine, Clinical and Health Psychology, College of Public Health and Health Professions
| | - Paul Kubilis
- Pharmaceutical Outcomes and Policy, College of Pharmacy
| | - Tobias Gerhard
- Ernest Mario School of Pharmacy and Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Richard Segal
- Pharmaceutical Outcomes and Policy, College of Pharmacy
| | - Jonathan J Shuster
- Health Outcomes and Policy, UF Clinical Research Center, College of Medicine, and
| | - Almut G Winterstein
- Pharmaceutical Outcomes and Policy, College of Pharmacy,,Epidemiology, College of Public Health and Health Professions and College of Medicine. University of Florida, Gainesville, Florida; and
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Lachaine J, Sikirica V, Mathurin K. Is adjunctive pharmacotherapy in attention-deficit/hyperactivity disorder cost-effective in Canada: a cost-effectiveness assessment of guanfacine extended-release as an adjunctive therapy to a long-acting stimulant for the treatment of ADHD. BMC Psychiatry 2016; 16:11. [PMID: 26774811 PMCID: PMC4715876 DOI: 10.1186/s12888-016-0708-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 01/05/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in children, with worldwide prevalence of ADHD varying from 5.9 to 7.1 %, depending on the reporter. In case of inadequate response to stimulants, combination therapy of stimulants and an adjunctive medication may improve the control of ADHD symptoms, reduce the dose-limiting adverse events, and help control comorbidities. To date, the only medication to be used for adjunctive therapy to psychostimulants is guanfacine extended release (GXR). The aim of this study was to assess the economic impact of GXR as an adjunct therapy with long-acting stimulants (GXR + stimulant) compared to long-acting stimulant monotherapy (stimulant alone) in the treatment of children and adolescents with ADHD in Canada. METHOD A Markov model was developed using health states defined based on the clinician-reported Clinical Global Impression-Severity (CGI-S) score (normal, mild, moderate, severe). Transition probabilities were calculated based on patient-level data from a published study. Long-acting stimulants available in Canada were considered in the base-case model: amphetamine mixed salts, methylphenidate HCl formulations, and lisdexamfetamine dimesylate. Analyses were conducted from a Canadian Ministry of Health (MoH; Ontario) and a societal perspective over a 1-year time horizon with weekly cycles. RESULTS Over a 1-year time horizon, GXR + stimulant was associated with 0.655 quality-adjusted life year (QALY), compared to 0.627 QALY with stimulant alone, for a gain of 0.028 QALY. From a MoH perspective, GXR+ stimulant and stimulant alone were associated with total costs of $CA1,617 and $CA949, respectively (difference of $CA668), which resulted in an incremental cost-effectiveness ratio (ICER) of $CA23,720/QALY. From a societal perspective, GXR + stimulant and stimulant alone were associated with total costs of $CA3,915 and $CA3,582, respectively (difference of $CA334), which resulted in an ICER of $CA11,845/QALY. Probabilistic sensitivity analysis (PSA) of GXR + stimulant showed that it remains a cost-effective strategy in 100 % of the simulations from both perspectives in numerous PSA and one-way sensitivity analyses, relative to a willingness to pay threshold of $50,000/QALY. CONCLUSIONS This economic evaluation demonstrates that GXR + stimulant is cost-effective compared to stimulant alone in the treatment of children and adolescents with ADHD in Canada.
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Affiliation(s)
- Jean Lachaine
- Faculty of Pharmacy, University of Montreal, P.O. Box 6128, Station Centre-ville, Montreal, Quebec, H3C 3J7, Canada.
| | - Vanja Sikirica
- Shire, 725 Chesterbrook Boulevard, Wayne, PA, 19087, USA.
| | - Karine Mathurin
- Faculty of Pharmacy, University of Montreal, P.O. Box 6128, Station Centre-ville, Montreal, Quebec, H3C 3J7, Canada.
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Lynch S, Bautista M, Freer C, Kalynych C, Cuffe S, Hendry P. Toward Effective Utilization of the Pediatric Emergency Department: The Case of ADHD. SOCIAL WORK IN PUBLIC HEALTH 2015; 31:9-18. [PMID: 26667350 DOI: 10.1080/19371918.2015.1087909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This project's purpose was to characterize attention-deficit/hyperactivity disorder (ADHD)-related emergency department (ED) visits compared with other psychiatric visits made by children with Medicaid and to determine whether any visits were avoidable. Medicaid claims of children who visited the ED for mental health services were analyzed. Logistic regression was used to examine whether demographic, ED-, and system-level variables increased the odds of an ED visit for children with Medicaid, comparing those with ADHD to other psychiatric diagnoses. Children who were African American, arrived during the daytime, and lived in counties with mental health professional shortages had greater odds of an ED visit for ADHD compared to other psychiatric visits. Approximately 24% of all ED visits were for ADHD and about 30% of these visits may have been avoidable. ADHD-related ED visits comprise a sizeable proportion of all ED visits. Some visits appeared to be emergent but possibly treatable in primary care.
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Affiliation(s)
- Sean Lynch
- a Department of Psychiatry , University of Florida-Jacksonville , Jacksonville , Florida , USA
- b Center for Health Equity & Quality Research, University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Maria Bautista
- b Center for Health Equity & Quality Research, University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Cecilia Freer
- b Center for Health Equity & Quality Research, University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Colleen Kalynych
- c Department of Emergency Medicine , University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Steven Cuffe
- a Department of Psychiatry , University of Florida-Jacksonville , Jacksonville , Florida , USA
| | - Phyllis Hendry
- c Department of Emergency Medicine , University of Florida-Jacksonville , Jacksonville , Florida , USA
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Evolution of stress in families of children with attention deficit hyperactivity disorder. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Guerro-Prado D, Mardomingo-Sanz M, Ortiz-Guerra J, García-García P, Soler-López B. Evolución del estrés familiar en niños con trastorno por déficit de atención con hiperactividad. An Pediatr (Barc) 2015; 83:328-35. [DOI: 10.1016/j.anpedi.2014.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/25/2014] [Accepted: 12/02/2014] [Indexed: 11/25/2022] Open
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Koisaari T, Michelsson K, Holopainen JM, Maksimainen R, Päivänsalo J, Rantala K, Tervo T. Traffic and Criminal Behavior of Adults with Attention Deficit-Hyperactivity with a Prospective Follow-Up from Birth to the Age of 40 Years. TRAFFIC INJURY PREVENTION 2015; 16:824-830. [PMID: 25837647 DOI: 10.1080/15389588.2015.1029068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether individuals with attention deficit-hyperactivity disorder (ADHD) followed up to age 40 have a higher mortality, more involvement in criminal behavior, increased traffic accidents, and frequency or registered violations against traffic rules or whether they have been more frequently victims to crimes. METHODS The ADHD cohort (N = 122) born in 1971-1974 was isolated at the age of 9 years from the base cohort of 865 children who had known risk factors at birth and were still alive at the age of 5 years. Ninety-four healthy individuals born during the same years served as control subjects. None of the individuals with ADHD had used psychostimulants before their adolescence. The follow-up data were available from the newborn period until the ages of 5 and 9 years. At the ages of 16 and 30, the data were collected via questionnaire. For this study, the national police registers (last 5 years) were examined for traffic violations, crimes, or being an object of a criminal act when the persons reached the age of 40 years. RESULTS Ten men and one woman with ADHD but none of the controls had died by the age of 40. Three died of disease-related incidents, and 8 (13%) died of abnormal causes such as suicide (3), traffic accident (2), substance abuse (2), or violence (1). During the follow-up period, individuals with ADHD had been involved in violent behavior or economic criminality more frequently than the control subjects. They were also more commonly victims of criminal acts. No difference was found in traffic citations between those with ADHD and control subjects (at 35-40 years) when all traffic crimes were considered. A difference was not observed in the frequency of traffic accidents. However, there was a significant difference in drunk driving (at the ages of 30 and 35-40) and the number of persons without a driver's license. DISCUSSION Subjects with ADHD showed an elevated risk of being involved in criminality and had a higher risk of dying before the age of 40 years. The early detection of ADHD in childhood and appropriate treatments and family support may decrease criminality and save both money and human distress.
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Affiliation(s)
- Tapio Koisaari
- a Finnish Motor Insurers' Centre , Helsinki , Finland
- b Department of Engineering Design and Production, Aalto University , Aalto , Finland
| | | | - Juha M Holopainen
- d Department of Ophthalmology, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | | | | | | | - Timo Tervo
- d Department of Ophthalmology, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Maia CR, Stella SF, Mattos P, Polanczyk GV, Polanczyk CA, Rohde LA. The Brazilian policy of withholding treatment for ADHD is probably increasing health and social costs. BRAZILIAN JOURNAL OF PSYCHIATRY 2015; 37:67-70. [DOI: 10.1590/1516-4446-2014-1378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022]
Affiliation(s)
- Carlos R. Maia
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | - Paulo Mattos
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | | | - Carisi A. Polanczyk
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Instituto de Avaliação de Tecnologia em Saúde (IATS), Brazil
| | - Luis A. Rohde
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
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Sun D, Abraham I, Slack M, Skrepnek GH. Emergency department visits in the United States for pediatric depression: estimates of charges and hospitalization. Acad Emerg Med 2014; 21:1003-14. [PMID: 25269581 DOI: 10.1111/acem.12457] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/04/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to calculate national estimates of depression-related emergency department (ED) visits and associated health care resource use among children and adolescents 17 years or younger. Another goal was to explore the effects of certain sociodemographic and health care system factors and comorbidities on ED charges and subsequent hospitalization in the United States. METHODS The authors analyzed data from the 2006 and 2009 National Emergency Department Sample (NEDS), the largest source of U.S. ED data. ED visits with all listed diagnoses (i.e., principal diagnosis plus secondary conditions) of depression were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 293.83, 296.2X, 296.3X, 300.4, and 311. Population-based estimates of ED visits, hospitalization, resource use, comorbidities, and demographics associated with pediatric depression were calculated. Potentially significant covariate associations were also explored using ED charges and hospital admission from the ED. RESULTS The 2006 and 2009 NEDS sample contained 365,713 ED visits for pediatric depression; the majority were made by adolescents (87.9%). Of these, 27.2% were admitted to the hospital, 69.5% were treated and released, and <0.1% died in ED. The ED charges in 2012 U.S. dollars summed to a hospital bill of $443.8 million, with the ED plus inpatient charges ($1.2 billion) being more than double that amount. The median inpatient length of stay (LOS) was 4.0 days. Suicide and intentional self-inflicted injury were attempted by 31.4% of the patients. Attention-deficit, conduct, and disruptive disorders; anxiety disorders; substance use disorders; asthma; and infections were the most common comorbidities. In year 2009, a higher number of diagnoses, older age, being female, key comorbidities, and suicide and intentional self-inflicted injury were significantly associated with higher ED charges (all p < 0.05). Increased odds of hospital admission from the ED were significantly associated with a higher number of diagnoses, key comorbidities, and suicide and intentional self-inflicted injury (all p < 0.05). CONCLUSIONS Pediatric depression is common in the ED and is associated with significant burden to the health care system. Certain factors such as a higher number of diagnoses, key comorbidities, and suicide and intentional self-inflicted injury are associated with increased health care costs and resource use. Special attention should be given to these factors, when present.
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Affiliation(s)
- Diana Sun
- The Center for Health Outcomes and PharmacoEconomic Research; College of Pharmacy; University of Arizona; Tucson AZ
| | - Ivo Abraham
- The Center for Health Outcomes and PharmacoEconomic Research; College of Pharmacy; University of Arizona; Tucson AZ
| | - Marion Slack
- The Center for Health Outcomes and PharmacoEconomic Research; College of Pharmacy; University of Arizona; Tucson AZ
| | - Grant H. Skrepnek
- The Oklahoma Health Sciences Center; College of Pharmacy; University of Oklahoma; Oklahoma City OK
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Kawatkar AA, Knight TK, Moss RA, Sikirica V, Chu LH, Hodgkins P, Haim Erder M, Nichol MB. Impact of mental health comorbidities on health care utilization and expenditure in a large US managed care adult population with ADHD. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:661-668. [PMID: 25236989 DOI: 10.1016/j.jval.2014.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 03/17/2014] [Accepted: 06/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To estimate the health resource use (HRU) and expenditure of adult patients with attention deficit/hyperactivity disorder (ADHD) subsequently diagnosed with one or more mental health (MH) comorbidities. METHODS Using Kaiser Permanente Southern California electronic medical records (January 1, 2006, to December 31, 2009), we identified adults with at least one ADHD diagnosis and at least two subsequent prescriptions fills for ADHD medication. The date of first MH comorbidity diagnosis after the index ADHD diagnosis was defined as the index transition date. Continuous eligibility 12 months before and after the index transition date was required. For patients with multiple transitions (≥2), the post-transition period reflected the 12 months after the second transition. HRU for all-cause inpatient, outpatient, emergency department, behavioral therapy, overall prescription fill counts, and ADHD-specific prescription fill counts and mean patient expenditure (2010 US $) were estimated. Generalized estimating equations were used to evaluate differences in HRU and expenditure between the pre- and post-transition periods, respectively. RESULTS Of the 3809 patients with ADHD identified, 989 (26%) had at least one transition (n = 357 single and n = 632 multiple). From the pre- to the post-transition period, for single transition cohort, all HRU increased significantly except for behavioral therapy. In the multiple transition cohort, all HRU increased significantly. Total expenditure increased by mean ± SE of $1822 ± $306 and $4432 ± $301 (both P < 0.0001) in the single and multiple transition cohorts, respectively. CONCLUSIONS Twenty-six percent of patients with ADHD transitioned to MH comorbid diagnoses. Increased HRU and expenditure were associated with MH transitions. Identifying of patients with ADHD at risk for MH comorbidities may help to improve their outcomes.
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Affiliation(s)
| | - Tara K Knight
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Robert A Moss
- Southern California Permanente Medical Group, Woodland Hills, CA
| | | | - Li-Hao Chu
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | - Michael B Nichol
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Kohlboeck G, Romanos M, Teuner CM, Holle R, Tiesler CMT, Hoffmann B, Schaaf B, Lehmann I, Herbarth O, Koletzko S, Bauer CP, von Berg A, Berdel D, Heinrich J. Healthcare use and costs associated with children's behavior problems. Eur Child Adolesc Psychiatry 2014; 23:701-14. [PMID: 24327267 DOI: 10.1007/s00787-013-0504-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
The objective of the study was to investigate associations between severity of behavior problems, specific symptom domains with healthcare use and costs in school-aged children. A cross-sectional study using data from the 10-year follow-up of two population-based birth cohorts was conducted on four rural and urban communities in Germany. There were 3,579 participants [1,834 boys (51%), 1,745 girls (49%)] on average aged 10.4 years. The severity levels (normal, at risk, abnormal) and symptom domains of behavioral problems were assessed by parent-reported strengths and difficulties questionnaire (SDQ).The outcomes were medical use categories (physicians, therapists, hospital, and rehabilitation), medical costs categories and total direct medical use and costs (calculated from parent-reported utilization of healthcare services during the last 12 months). Total direct medical costs showed a graded relationship with severity level (adjusted p < 0.0001). Average annual cost difference in total direct medical costs between at risk and normal total difficulties was Euro (<euro>) 271 (SD 858), and <euro> 1,237 (SD 2,528) between abnormal and normal total difficulties. A significant increase in physician costs showed between children with normal and at risk total difficulties (1.30), and between normal and abnormal total difficulties (1.29; p < 0.0001). Between specific symptom domains, children with emotional symptoms showed highest costs for physicians, psychotherapist, and hospitalization as well as total direct medical costs. Children with hyperactivity/inattention showed highest costs for therapists and emergency room costs. Healthcare use and costs are related to the severity of child behavior problems. In general, children's costs for psychotherapy treatments have been low relative to general medical treatments which may indicate that some children with behavioral problems did not get appropriate care. To some degree, medical conditions may be attributable to some of the high hospitalization costs found in children with emotional symptom.
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Affiliation(s)
- Gabriele Kohlboeck
- Institute of Epidemiology I, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany,
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Corkum P, Bessey M, McGonnell M, Dorbeck A. Barriers to evidence-based treatment for children with attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2014; 7:49-74. [PMID: 25055885 DOI: 10.1007/s12402-014-0152-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 07/08/2014] [Indexed: 01/09/2023]
Abstract
A number of evidence-based treatments are available for attention-deficit/hyperactivity disorder (ADHD), including pharmacological, psychosocial, or a combination of the two treatments. For a significant number of children diagnosed with ADHD, however, these treatments are not utilized or adhered to for the recommended time period. Given that adherence to treatment regimens is necessary for reducing the symptoms of ADHD, it is crucial to develop a comprehensive understanding of why adherence rates are so low. The current review examines the literature to date that has directly explored utilization and adherence issues related to the treatment of ADHD in order to identify the key barriers to treatment. This review focused on four main factors that could account for the poor rates of treatment utilization and adherence: personal characteristics (socio-demographic characteristics and diagnostic issues), structural barriers, barriers related to the perception of ADHD, and barriers related to perceptions of treatment for ADHD. This review included 63 papers and covered a variety of barriers to treatment that have been found in research to have an impact on treatment adherence. Based on this review, we conclude that there are complex and interactive relationships among a variety of factors that influence treatment utilization and adherence. Four main gaps in the literature were identified: (1) there is limited information about barriers to psychosocial interventions, compared to pharmacological interventions; (2) there is a limited variety of research methodology being utilized; (3) treatment barrier knowledge is mostly from parents' perspectives; and (4) treatment utilization and treatment adherence are often studied jointly. Information from this review can help practitioners to identify potential barriers to their clients being adherent to treatment recommendations.
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Affiliation(s)
- Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada,
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D'Amico F, Knapp M, Beecham J, Sandberg S, Taylor E, Sayal K. Use of services and associated costs for young adults with childhood hyperactivity/conduct problems: 20-year follow-up. Br J Psychiatry 2014; 204:441-7. [PMID: 24676966 DOI: 10.1192/bjp.bp.113.131367] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although childhood hyperactivity and conduct problems are associated with difficulties in adulthood, little is known about later service use or public expenditure costs in the UK. AIMS To describe the use of services and calculate recent (past 6 months) and early adulthood (since the age of 18 years) public expenditure costs incurred by young adults who had hyperactivity and/or conduct problems during childhood. METHOD A 20-year follow-up of a community sample of 6- to 7-year-old boys (n = 83) with hyperactivity only, conduct problems only, mixed hyperactivity and conduct problems, and no behaviour problems (control). Information was obtained about service use; recent (past 6 months), and early adulthood (since age 18 years) public expenditure costs were calculated. RESULTS High levels of childhood conduct problems were associated with a two- to threefold increase in early adulthood costs, mainly driven by criminal justice contacts. Although the mixed problems group had the highest recent costs in terms of receipt of benefits and health and social care, they had the lowest criminal justice costs. CONCLUSIONS High levels of early childhood conduct problems are particularly associated with increased health, social care and criminal justice costs in adulthood.
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Affiliation(s)
- Francesco D'Amico
- Francesco D'Amico, PhD, Personal Social Services Research Unit, London School of Economics and Political Science; Martin Knapp, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Centre for the Economics of Mental and Physical Health, King's College London, Institute of Psychiatry; Jennifer Beecham, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Personal Social Services Research Unit, University of Kent; Seija Sandberg, MD, FRCPsych, Mental Health Sciences Unit, University College London; Eric Taylor, MB, FRCPsych(Hon), Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry; Kapil Sayal, MRCPsych, PhD, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Martin Knapp
- Francesco D'Amico, PhD, Personal Social Services Research Unit, London School of Economics and Political Science; Martin Knapp, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Centre for the Economics of Mental and Physical Health, King's College London, Institute of Psychiatry; Jennifer Beecham, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Personal Social Services Research Unit, University of Kent; Seija Sandberg, MD, FRCPsych, Mental Health Sciences Unit, University College London; Eric Taylor, MB, FRCPsych(Hon), Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry; Kapil Sayal, MRCPsych, PhD, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Jennifer Beecham
- Francesco D'Amico, PhD, Personal Social Services Research Unit, London School of Economics and Political Science; Martin Knapp, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Centre for the Economics of Mental and Physical Health, King's College London, Institute of Psychiatry; Jennifer Beecham, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Personal Social Services Research Unit, University of Kent; Seija Sandberg, MD, FRCPsych, Mental Health Sciences Unit, University College London; Eric Taylor, MB, FRCPsych(Hon), Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry; Kapil Sayal, MRCPsych, PhD, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Seija Sandberg
- Francesco D'Amico, PhD, Personal Social Services Research Unit, London School of Economics and Political Science; Martin Knapp, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Centre for the Economics of Mental and Physical Health, King's College London, Institute of Psychiatry; Jennifer Beecham, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Personal Social Services Research Unit, University of Kent; Seija Sandberg, MD, FRCPsych, Mental Health Sciences Unit, University College London; Eric Taylor, MB, FRCPsych(Hon), Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry; Kapil Sayal, MRCPsych, PhD, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Eric Taylor
- Francesco D'Amico, PhD, Personal Social Services Research Unit, London School of Economics and Political Science; Martin Knapp, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Centre for the Economics of Mental and Physical Health, King's College London, Institute of Psychiatry; Jennifer Beecham, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Personal Social Services Research Unit, University of Kent; Seija Sandberg, MD, FRCPsych, Mental Health Sciences Unit, University College London; Eric Taylor, MB, FRCPsych(Hon), Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry; Kapil Sayal, MRCPsych, PhD, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Kapil Sayal
- Francesco D'Amico, PhD, Personal Social Services Research Unit, London School of Economics and Political Science; Martin Knapp, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Centre for the Economics of Mental and Physical Health, King's College London, Institute of Psychiatry; Jennifer Beecham, PhD, Personal Social Services Research Unit, London School of Economics and Political Science, and Personal Social Services Research Unit, University of Kent; Seija Sandberg, MD, FRCPsych, Mental Health Sciences Unit, University College London; Eric Taylor, MB, FRCPsych(Hon), Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry; Kapil Sayal, MRCPsych, PhD, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, UK
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Chow SJ, Sciberras E, Gillam LH, Green J, Efron D. Paediatricians' decision making about prescribing stimulant medications for children with attention-deficit/hyperactivity disorder. Child Care Health Dev 2014; 40:301-8. [PMID: 23445484 DOI: 10.1111/cch.12036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is now the most common reason for a child to present to a paediatrician in Australia. Stimulant medications are commonly prescribed for children with ADHD, to reduce symptoms and improve function. In this study we investigated the factors that influence paediatricians' decisions about prescribing stimulant medications. METHOD In-depth, semi-structured interviews were conducted with paediatricians (n = 13) who were purposively recruited so as to sample a broad demographic of paediatricians working in diverse clinical settings. Paediatricians were recruited from public outpatient and private paediatrician clinics in Victoria, Australia. The interviews were audio-recorded and transcribed verbatim for thematic analysis. Paediatricians also completed a questionnaire describing their demographic and practice characteristics. RESULTS Our findings showed that the decision to prescribe is a dynamic process involving two key domains: (1) weighing up clinical factors; and (2) interacting with parents and the patient along the journey to prescribing. Five themes relating to this process emerged from data analysis: comprehensive assessments that include history, examination and information from others; influencing factors such as functional impairment and social inclusion; previous success; facilitating parental understanding including addressing myths and parental confusion; and decision-making model. CONCLUSIONS Paediatricians' decisions to prescribe stimulant medications are influenced by multiple factors that operate concurrently and interdependently. Paediatricians do not make decisions about prescribing in isolation; rather, they actively involve parents, teachers and patients, to arrive at a collective, well-informed decision.
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Affiliation(s)
- S-J Chow
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Vic., Australia
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Narayan S, Hay J. Cost effectiveness of methylphenidate versus AMP/DEX mixed salts for the first-line treatment of ADHD. Expert Rev Pharmacoecon Outcomes Res 2014; 4:625-34. [DOI: 10.1586/14737167.4.6.625] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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