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.
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。