Klora Mike, Zeidler Jan, Linder Roland, Verheyen Frank, von der Schulenburg J-Matthias Graf
Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, Hannover, 30159, Germany.
Scientific Institute of TK for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany.
Health Econ Rev. 2015 Dec;5(1):40. doi: 10.1186/s13561-015-0078-y. Epub 2015 Dec 21.
The costs and treatment patterns of attention deficit hyperactivity disorder (ADHD) are subjects of health services research in Germany and worldwide. Previous publications focused mainly on prevalent patients and thus research gaps were identified regarding costs and treatment patterns of incident patients before and after the first diagnosis.
Analyses were conducted using claims data obtained from a large German sickness fund (Techniker Krankenkasse). Inclusion criteria consisted of patients with at least two secured outpatient or one inpatient ADHD diagnosis in 2007. Incidence was ensured by defining a baseline period without ADHD-diagnosis in 2006. In addition to diseaserelated cost analyses compared to a control group including age group comparisons, comorbidities, the proportion of multimodal treatment and medication treatment patterns were described.
In total, 9083 newly diagnosed ADHD patients were identified (73 % male; mean age: 12.9 years (SD: 10.3)). The mean total cost of ADHD patients during the year after the first diagnosis exceeded the mean total cost of the year before by 976 € (Differencein-Difference-estimator: 1006 €). Our analyses have shown that 10 % of ADHD patients have been treated with multimodal therapy. In addition, 11 % of the investigated ADHD population have received methylphenidate or atomoxetine preceeding the date of diagnosis in the relevant observation period.
This study provides important insights into the costs as well as the treatment patterns of incident ADHD patients. ADHD-related costs and medications can be identified prior to the date of the first ADHD diagnosis. Although, multimodal therapy is presented as an optimal treatment option by many international guidelines and experts, its proportion for treatment is low (10 %). Further research is necessary to identify reasons for the low proportion of multimodal therapy and (cost-)effectiveness has to be evaluated in comparison to other treatment options. In addition, ADHD-related costs could be identified before the first diagnosis is documented. The reasons for medication prior to diagnosis have to be further investigated.
注意缺陷多动障碍（ADHD）的成本及治疗模式是德国乃至全球卫生服务研究的课题。以往的出版物主要关注现患患者，因此在首次诊断前后新发病例的成本和治疗模式方面存在研究空白。
使用从德国一家大型疾病基金（Techniker Krankenkasse）获取的理赔数据进行分析。纳入标准包括2007年至少有两次确诊门诊或一次住院ADHD诊断的患者。通过定义2006年无ADHD诊断的基线期来确保发病率。除了与对照组进行疾病相关成本分析（包括年龄组比较、合并症）外，还描述了多模式治疗的比例和药物治疗模式。
共识别出9083例新诊断的ADHD患者（73%为男性；平均年龄：12.9岁（标准差：10.3））。首次诊断后一年ADHD患者的平均总成本比前一年的平均总成本高出976欧元（差异-in-差异估计值：1006欧元）。我们的分析表明，10%的ADHD患者接受了多模式治疗。此外，在相关观察期内，11%的被调查ADHD人群在诊断日期之前接受过哌甲酯或托莫西汀治疗。
本研究为新发病例ADHD患者的成本及治疗模式提供了重要见解。与ADHD相关的成本和药物可在首次ADHD诊断日期之前识别。尽管许多国际指南和专家将多模式治疗作为最佳治疗选择，但接受该治疗的比例较低（10%）。需要进一步研究以确定多模式治疗比例低的原因，并与其他治疗选择相比评估其（成本）效益。此外，在首次诊断记录之前就可识别出与ADHD相关的成本。诊断前用药的原因必须进一步调查。
