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Abstract：
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) has been shown to pose considerable clinical and economic burden; however, research quantifying the excess burden attributable to common psychiatric comorbidities of ADHD among pediatric patients is scarce. This study assessed the impact of anxiety and depression on healthcare resource utilization (HRU) and healthcare costs in pediatric patients with ADHD in the United States.
METHODS: Patients with ADHD aged 6-17 years were identified in the IQVIA PharMetrics Plus database (10/01/2015-09/30/2021). The index date was the date of initiation of a randomly selected ADHD treatment. Patients with ≥ 1 diagnosis for anxiety and/or depression during both the baseline (6 months pre-index) and study period (12 months post-index) were classified in the ADHD+anxiety/depression cohort; those without diagnoses for anxiety nor depression during both periods were classified in the ADHD-only cohort. Entropy balancing was used to create reweighted cohorts. All-cause HRU and healthcare costs during the study period were compared using regression analyses. Cost analyses were also performed in subgroups by comorbid conditions.
RESULTS: The reweighted ADHD-only cohort (N = 204,723) and ADHD+anxiety/depression cohort (N = 66,231) had similar characteristics (mean age: 11.9 years; 72.8% male; 56.2% had combined inattentive and hyperactive ADHD type). The ADHD+anxiety/depression cohort had higher HRU than the ADHD-only cohort (incidence rate ratios for inpatient admissions: 10.3; emergency room visits: 1.6; outpatient visits: 2.3; specialist visits: 5.3; and psychotherapy visits: 6.1; all p < 0.001). The higher HRU translated to greater all-cause healthcare costs; the mean per-patient-per-year (PPPY) costs in the ADHD-only cohort vs. ADHD+anxiety/depression cohort was $3,988 vs. $8,682 (p < 0.001). All-cause healthcare costs were highest when both comorbidities were present; among patients with ADHD who had only anxiety, only depression, and both anxiety and depression, the mean all-cause healthcare costs were $7,309, $9,901, and $13,785 PPPY, respectively (all p < 0.001).
CONCLUSIONS: Comorbid anxiety and depression was associated with significantly increased risk of HRU and higher healthcare costs among pediatric patients with ADHD; the presence of both comorbid conditions resulted in 3.5 times higher costs relative to ADHD alone. These findings underscore the need to co-manage ADHD and psychiatric comorbidities to help mitigate the substantial burden borne by patients and the healthcare system.
METHODS: Patients with ADHD aged 6-17 years were identified in the IQVIA PharMetrics Plus database (10/01/2015-09/30/2021). The index date was the date of initiation of a randomly selected ADHD treatment. Patients with ≥ 1 diagnosis for anxiety and/or depression during both the baseline (6 months pre-index) and study period (12 months post-index) were classified in the ADHD+anxiety/depression cohort; those without diagnoses for anxiety nor depression during both periods were classified in the ADHD-only cohort. Entropy balancing was used to create reweighted cohorts. All-cause HRU and healthcare costs during the study period were compared using regression analyses. Cost analyses were also performed in subgroups by comorbid conditions.
RESULTS: The reweighted ADHD-only cohort (N = 204,723) and ADHD+anxiety/depression cohort (N = 66,231) had similar characteristics (mean age: 11.9 years; 72.8% male; 56.2% had combined inattentive and hyperactive ADHD type). The ADHD+anxiety/depression cohort had higher HRU than the ADHD-only cohort (incidence rate ratios for inpatient admissions: 10.3; emergency room visits: 1.6; outpatient visits: 2.3; specialist visits: 5.3; and psychotherapy visits: 6.1; all p < 0.001). The higher HRU translated to greater all-cause healthcare costs; the mean per-patient-per-year (PPPY) costs in the ADHD-only cohort vs. ADHD+anxiety/depression cohort was $3,988 vs. $8,682 (p < 0.001). All-cause healthcare costs were highest when both comorbidities were present; among patients with ADHD who had only anxiety, only depression, and both anxiety and depression, the mean all-cause healthcare costs were $7,309, $9,901, and $13,785 PPPY, respectively (all p < 0.001).
CONCLUSIONS: Comorbid anxiety and depression was associated with significantly increased risk of HRU and higher healthcare costs among pediatric patients with ADHD; the presence of both comorbid conditions resulted in 3.5 times higher costs relative to ADHD alone. These findings underscore the need to co-manage ADHD and psychiatric comorbidities to help mitigate the substantial burden borne by patients and the healthcare system.
摘要：
背景：注意缺陷/多动障碍（ADHD）已被证明会造成相当大的临床和经济负担；然而，量化儿科患者中由多动症常见精神病合并症引起的额外负担的研究很少.这项研究评估了焦虑和抑郁对美国ADHD儿科患者医疗资源利用（HRU）和医疗费用的影响。
方法：在IQVIAPharMetricsPlus数据库（10/01/2015-09/30/2021）中确定了年龄在6-17岁的ADHD患者。索引日期是开始随机选择的ADHD治疗的日期。在基线（指标前6个月）和研究期间（指标后12个月）诊断为焦虑和/或抑郁的患者被分类为ADHD焦虑/抑郁队列；在这两个时期没有诊断为焦虑或抑郁的患者被分类为仅ADHD队列。熵平衡用于创建重新加权的队列。使用回归分析比较了研究期间的全因HRU和医疗费用。还根据合并症在亚组中进行了成本分析。
结果：仅重新加权的ADHD队列（N=204,723）和ADHD焦虑/抑郁队列（N=66,231）具有相似的特征（平均年龄：11.9岁；72.8％的男性；56.2％的人合并注意力不集中和过度活跃的ADHD类型）。ADHD+焦虑/抑郁队列的HRU高于仅ADHD队列（住院率：10.3；急诊室就诊：1.6；门诊就诊：2.3；专家就诊：5.3；心理治疗就诊：6.1；所有p<0.001）。较高的HRU意味着更高的全因医疗保健成本；仅ADHD队列中平均每患者每年(PPPY)成本与ADHD+焦虑/抑郁队列为3,988美元，而不是8682美元（p<0.001）。当同时存在两种合并症时，所有原因的医疗费用最高；在只有焦虑症的ADHD患者中，只有抑郁症,焦虑和抑郁，所有原因的平均医疗费用为7309美元、9901美元和13785美元，分别(所有p<0.001)。
结论：在患有ADHD的儿科患者中，焦虑和抑郁与HRU风险显著增加和医疗费用增加相关；两种合并症的存在导致费用相对于单独的ADHD高3.5倍。这些发现强调了共同管理ADHD和精神病合并症的必要性，以帮助减轻患者和医疗保健系统承担的巨大负担。
方法：在IQVIAPharMetricsPlus数据库（10/01/2015-09/30/2021）中确定了年龄在6-17岁的ADHD患者。索引日期是开始随机选择的ADHD治疗的日期。在基线（指标前6个月）和研究期间（指标后12个月）诊断为焦虑和/或抑郁的患者被分类为ADHD焦虑/抑郁队列；在这两个时期没有诊断为焦虑或抑郁的患者被分类为仅ADHD队列。熵平衡用于创建重新加权的队列。使用回归分析比较了研究期间的全因HRU和医疗费用。还根据合并症在亚组中进行了成本分析。
结果：仅重新加权的ADHD队列（N=204,723）和ADHD焦虑/抑郁队列（N=66,231）具有相似的特征（平均年龄：11.9岁；72.8％的男性；56.2％的人合并注意力不集中和过度活跃的ADHD类型）。ADHD+焦虑/抑郁队列的HRU高于仅ADHD队列（住院率：10.3；急诊室就诊：1.6；门诊就诊：2.3；专家就诊：5.3；心理治疗就诊：6.1；所有p<0.001）。较高的HRU意味着更高的全因医疗保健成本；仅ADHD队列中平均每患者每年(PPPY)成本与ADHD+焦虑/抑郁队列为3,988美元，而不是8682美元（p<0.001）。当同时存在两种合并症时，所有原因的医疗费用最高；在只有焦虑症的ADHD患者中，只有抑郁症,焦虑和抑郁，所有原因的平均医疗费用为7309美元、9901美元和13785美元，分别(所有p<0.001)。
结论：在患有ADHD的儿科患者中，焦虑和抑郁与HRU风险显著增加和医疗费用增加相关；两种合并症的存在导致费用相对于单独的ADHD高3.5倍。这些发现强调了共同管理ADHD和精神病合并症的必要性，以帮助减轻患者和医疗保健系统承担的巨大负担。
