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Gesundheitsökonomie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung in Deutschland

Teil 1: Versorgungsepidemiologie und Krankheitskosten

The health economics of attention deficit hyperactivity disorder in Germany

Part 1: health care utilization and cost of illness

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Zusammenfassung

Die Diagnose einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) wird administrativen Daten aus Nordbaden zufolge bei 5% aller 7- bis 12-jährigen Kinder und bei 1,3% der 13- bis 19-jährigen Jugendlichen gestellt, davon in rund zwei Drittel der Fälle ohne Einbezug eines psychiatrisch spezialisierten Arztes. Zur Qualitätssicherung der medizinischen Betreuung der betroffenen Kinder und Jugendlichen hat die Vertragswerkstatt der Kassenärztlichen Bundesvereinigung nunmehr ein interdisziplinär ausgerichtetes, an den Leitlinien der Fachgesellschaften orientiertes Versorgungskonzept vorgelegt. Vor diesem Hintergrund werden vorliegende Daten zur Epidemiologie, Komorbidität einschließlich differenzialdiagnostischer Überlegungen sowie zur Versorgung und den ökonomischen Konsequenzen der ADHS präsentiert. Anhand von Abrechnungs- und Verordnungsdaten aus Nordbaden lassen sich mehr als 2,5fach höhere direkte Kosten für Kinder und Jugendliche mit ADHS gegenüber einer bezüglich Alter, Geschlecht und Kassenzugehörigkeit identischen Kontrollgruppe nachweisen. Die Dimension der hieraus der Gesetzlichen Krankenversicherung in Deutschland erwachsenden Kostenbelastung dürfte sich damit im Jahr 2003 in einer Größenordnung um 260 Mio. EUR bewegt und seither weiter zugenommen haben. Darüber hinaus ist die ADHS mit erheblichen indirekten Kosten assoziiert. Es erscheint trotz erheblicher noch bestehender Datenlücken wahrscheinlich, dass die volkswirtschaftlichen Kosten der ADHS insgesamt jenen von Alkoholabusus- und Abhängigkeitserkrankungen vergleichbar sein könnten. Gesundheitsökonomische Analysen werden daher für die Versorgung von ADHS-Patienten erheblich an Bedeutung gewinnen.

Summary

In the German region of Nordbaden, 5% of children (aged 7–12 years) and 1.3% of adolescents (aged 13–19 years) were diagnosed with attention deficit hyperactivity disorder (ADHD) in 2003. About two thirds of these patients were not seen by a physician specialized in psychiatry. Now the National Association of Statutory Health Insurance Physicians in Germany (Kassenaerztliche Bundesvereinigung, KBV) has developed a proposal for the integrated provision of care for these patients, combining a guidelines-oriented multidisciplinary approach with a system of quality assurance. Against this background, currently available ADHD-related data are presented, covering epidemiology, comorbidity and differential diagnosis, health care utilization, and cost of illness. According to administrative data analyses from Nordbaden, direct medical costs for patients with ADHD, from the perspective of statutory health insurance (SHI), exceed those of matched controls by a factor of >2.5. On this basis, ADHD-related expenditures of the German SHI may be estimated at around EUR 260 million in 2003, and almost certainly will have continued to grow further since. In addition to this, a diagnosis of ADHD is associated with substantial indirect cost. Although the literature on the burden of ADHD is incomplete, it seems plausible that the cost of illness might be comparable to that reported for alcohol and addiction disorders. Thus we anticipate an increasing relevance of formal health economic evaluations of health care programs offered to patients with ADHD.

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Notes

  1. bis Dezember 2008

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Authors and Affiliations

  1. Institute for Innovation & Valuation in Health Care (InnoValHC), An der Ringkirche 4, 65197, Wiesbaden, Deutschland

    M. Schlander M.B.A., G.-E. Trott & O. Schwarz

  2. Institut für Public Health, Sozial- und Präventivmedizin, Universität Heidelberg, Medizinische Fakultät Mannheim , Heidelberg, Deutschland

    M. Schlander M.B.A.

  3. Hochschule für Wirtschaft Ludwigshafen am Rhein, Ludwigshafen, Deutschland

    M. Schlander M.B.A.

  4. Praxis Prof. Trott/Dr. Wirth, Aschaffenburg, Deutschland

    G.-E. Trott

  5. Hochschule Heilbronn, Heilbronn, Deutschland

    O. Schwarz

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Schlander, M., Trott, GE. & Schwarz, O. Gesundheitsökonomie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung in Deutschland. Nervenarzt 81, 289–300 (2010). https://doi.org/10.1007/s00115-009-2888-9

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