Guevara James P, Mandell David S, Rostain Anthony L, Zhao Huaqing, Hadley Trevor R
Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Pediatrics. 2003 Dec;112(6 Pt 1):e440. doi: 10.1542/peds.112.6.e440.
Children with attention-deficit/hyperactivity disorder and asthma incur similar health care costs that are greater than those of most children without these conditions. Preliminary findings suggest that children with emotional behavioral disorders, anxiety and depression, incur even greater costs.
To determine if children with behavioral disorders have similar health services expenditures as children with physical conditions and to assess whether children with emotional behavioral disorders incur greater expenditures than children with disruptive behavioral disorders.
Children 2 to 18 years old who were members of households participating in the 1996 Medical Expenditure Panel Survey were eligible for this retrospective cohort study. Children with common behavioral disorders selected a priori were identified by using truncated International Classification of Diseases (Ninth Revision) codes obtained from household interviews. Children with common physical conditions (asthma, epilepsy, and diabetes) and children without these conditions served as controls. Estimates were weighted to reflect the complex sampling scheme. Expenditures for health services were compared.
Of 3955 eligible children weighted to represent >44 million, 7.1% were identified with a behavioral disorder: 4.5% with disruptive disorders; 2.1% with emotional disorders; and 0.5% with miscellaneous disorders. Children with behavioral disorders incurred overall expenditures similar to children with physical conditions (adjusted 1492 dollars vs 1245 dollars; P =.18) but greater than children without these conditions (adjusted 1492 dollars vs 834 dollars; P =.001). Children with behavioral disorders had greater expenditures for office-based visits (adjusted 410 dollars; 95% confidence interval: 146-672 dollars) and prescription medications (adjusted 361 dollars; 95% confidence interval: 72-648 dollars) than those of children in either control group. Among children with behavioral disorders, children with emotional disorders incurred substantially greater overall expenditures (adjusted 2152 dollars vs 1026 dollars; P =.003) than children with disruptive disorders. Children with emotional disorders incurred greater hospitalization expenditures (664 dollars vs 43 dollars; P =.01) but lower pharmacy expenditures (154 dollars vs 307 dollars; P =.001) than children with disruptive disorders.
In this nationally representative sample, children with behavioral disorders incurred overall health care costs similar to children with physical conditions but greater than children without any of these conditions because of increased costs for office-based visits and prescription medications. However, costs were not uniform among children with behavioral disorders. Children with emotional disorders incurred twofold higher costs than children with disruptive disorders. Greater recognition of children with emotional disorders and efforts to address the high rate of hospitalizations in this population are warranted.
患有注意力缺陷/多动障碍和哮喘的儿童产生的医疗保健费用与大多数没有这些疾病的儿童相比更高且相似。初步研究结果表明，患有情绪行为障碍、焦虑和抑郁的儿童产生的费用甚至更高。
确定患有行为障碍的儿童与患有身体疾病的儿童的医疗服务支出是否相似，并评估患有情绪行为障碍的儿童是否比患有破坏性行为障碍的儿童产生更高的支出。
参与1996年医疗支出小组调查的家庭中的2至18岁儿童符合这项回顾性队列研究的条件。通过使用从家庭访谈中获得的截断的国际疾病分类（第九版）编码，预先确定患有常见行为障碍的儿童。患有常见身体疾病（哮喘、癫痫和糖尿病）的儿童以及没有这些疾病的儿童作为对照。估计值经过加权以反映复杂的抽样方案。比较医疗服务支出。
在加权后代表超过4400万儿童的3955名符合条件的儿童中，7.1%被确定患有行为障碍：4.5%患有破坏性行为障碍；2.1%患有情绪障碍；0.5%患有其他障碍。患有行为障碍的儿童产生的总体支出与患有身体疾病的儿童相似（调整后为1492美元对1245美元；P = 0.18），但高于没有这些疾病的儿童（调整后为1492美元对834美元；P = 0.001）。患有行为障碍的儿童在门诊就诊（调整后为410美元；95%置信区间：146 - 672美元）和处方药（调整后为361美元；95%置信区间：72 - 648美元）方面的支出高于两个对照组中的任何一组儿童。在患有行为障碍的儿童中，患有情绪障碍的儿童产生的总体支出（调整后为2152美元对1026美元；P = 0.003）比患有破坏性行为障碍的儿童高得多。患有情绪障碍的儿童的住院支出（664美元对43美元；P = 0.01）高于患有破坏性行为障碍的儿童，但药房支出（154美元对307美元；P = 0.001）低于患有破坏性行为障碍的儿童。
在这个具有全国代表性的样本中，患有行为障碍的儿童产生的总体医疗保健费用与患有身体疾病的儿童相似，但由于门诊就诊和处方药费用增加，高于没有这些疾病的儿童。然而，患有行为障碍的儿童的费用并不统一。患有情绪障碍的儿童产生的费用是患有破坏性行为障碍的儿童的两倍。有必要更加关注患有情绪障碍的儿童，并努力解决该人群中高住院率的问题。
