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National Estimates From the Medical Expenditure Panel Survey

Eugenia Chan, MD, MPH; Chunliu Zhan, MD, PhD; Charles J. Homer, MD, MPH

Arch Pediatr Adolesc Med. 2002;156:504-511.

Context  Although attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent chronic condition of childhood, little is known about patterns of health care use and associated expenditures.

Objective  To compare health care use and costs among children with ADHD, children with asthma, and the general pediatric population.

Design and Setting  The 1996 Medical Expenditure Panel Survey, a nationally representative household survey.

Participants  All 5439 children aged 5 to 20 years from the 1996 Medical Expenditure Panel Survey were included in this analysis. Children who had ADHD, asthma, or neither (general population) were identified from International Classification of Diseases, Ninth Revision, Clinical Modification codes and prescription records.

Main Outcome Measures  Mean health care use (outpatient visits, emergency department visits, hospital stays, home health visit days, and prescriptions) and associated expenditures.

Results  We identified 165 children with ADHD, 322 with asthma, and 4952 with neither diagnosis. Children with ADHD had significantly higher mean total health care costs ($1151) compared with children with asthma ($1091; P<.05) and the general population ($712; P<.001). After adjusting for age, sex, race, household income, access to care, parent education, and marital status, excess total costs were $479 for children with ADHD (P<.001) and $437 for children with asthma (P<.01).

Conclusions  Overall costs of care for children with ADHD are comparable to costs for children with asthma and significantly greater than for the general pediatric population. Specific types of health care use and the sources of expenditures differ between children with ADHD and children with asthma. Because much ADHD-related care occurs within school and mental health settings, these figures likely underestimate the true costs of caring for children with this condition.

From the Division of General Pediatrics, Children's Hospital Boston, Boston, Mass (Drs Chan and Homer); and the Agency for Healthcare Research and Quality, Rockville, Md (Dr Zhan).

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