IDEAS home Printed from
   My bibliography  Save this article

Global Economic Burden of Attention-Deficit/Hyperactivity Disorder: A Systematic Review


  • Anindit Chhibber

    (University of Utah)

  • Alexandre Hikiji Watanabe

    (University of Utah)

  • Chayutthaphong Chaisai

    (Monash University)

  • Sajesh K. Veettil

    (University of Utah)

  • Nathorn Chaiyakunapruk

    (University of Utah
    Monash University)


Background Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children and adults. Previous systematic reviews have provided estimates of ADHD-associated costs but were limited to the USA and Europe. Objectives This study aimed to systematically summarise all global evidence on the economic burden of ADHD. Methods A systematic search for published studies on costs of ADHD was conducted in EconLit, EMBASE, PubMed, ERIC, and PsycINFO. Additional literature was identified by searching the reference lists of eligible studies. The quality of the studies was assessed using the Larg and Moss checklist. Results This review included 44 studies. All studies were conducted in high-income countries and were limited to North America and Europe except for four studies: two in Asia and two in Australia. Most studies were retrospective and undertook a prevalence-based study design. Analysis revealed a substantial economic impact associated with ADHD. Estimates based on total costs ranged from $US831.38 to 20,538 for per person estimates and from $US356 million to 20.27 billion for national estimates. Estimates based on marginal costs ranged from $US244.15 to 18,751.00 for per person estimates and from $US12.18 million to 141.33 billion for national estimates. Studies that calculated economic burden across multiple domains of direct, indirect, and education and justice system costs for both children and adults with ADHD reported higher costs and translated gross domestic product than did studies that captured only a single domain or age group. Conclusions Despite the wide variation in methodologies in studies reviewed, the literature suggests that ADHD imposes a substantial economic burden on society. There is a dire need for cost-of-illness research in low- and middle-income countries to better inform the treatment and management of ADHD in these countries. In addition, guidelines on the conduct and reporting of economic burden studies are needed as they may improve standardisation of cost-of-illness studies.

Suggested Citation

  • Anindit Chhibber & Alexandre Hikiji Watanabe & Chayutthaphong Chaisai & Sajesh K. Veettil & Nathorn Chaiyakunapruk, 2021. "Global Economic Burden of Attention-Deficit/Hyperactivity Disorder: A Systematic Review," PharmacoEconomics, Springer, vol. 39(4), pages 399-420, April.
  • Handle: RePEc:spr:pharme:v:39:y:2021:i:4:d:10.1007_s40273-020-00998-0
    DOI: 10.1007/s40273-020-00998-0

    Download full text from publisher

    File URL:
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL:
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    Full references (including those not matched with items on IDEAS)


    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Journal round-up: PharmacoEconomics 39(4)
      by Chris Sampson in The Academic Health Economists' Blog on 2021-06-15 06:00:05


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Xianying Min & Chao Li & Yan Yan, 2021. "Parental Age and the Risk of ADHD in Offspring: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 18(9), pages 1-14, May.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Santos Urbina & Sofía Villatoro & Jesús Salinas, 2021. "Self-Regulated Learning and Technology-Enhanced Learning Environments in Higher Education: A Scoping Review," Sustainability, MDPI, vol. 13(13), pages 1-12, June.
    2. García-Poole, Chloe & Byrne, Sonia & Rodrigo, María José, 2019. "How do communities intervene with adolescents at psychosocial risk? A systematic review of positive development programs," Children and Youth Services Review, Elsevier, vol. 99(C), pages 194-209.
    3. Bishal Mohindru & David Turner & Tracey Sach & Diana Bilton & Siobhan Carr & Olga Archangelidi & Arjun Bhadhuri & Jennifer A. Whitty, 2020. "Health State Utility Data in Cystic Fibrosis: A Systematic Review," PharmacoEconomics - Open, Springer, vol. 4(1), pages 13-25, March.
    4. Pelai, Ricardo & Hagerman, Shannon M. & Kozak, Robert, 2020. "Biotechnologies in agriculture and forestry: Governance insights from a comparative systematic review of barriers and recommendations," Forest Policy and Economics, Elsevier, vol. 117(C).
    5. Wesam Salah Alaloul & Muhammad Altaf & Muhammad Ali Musarat & Muhammad Faisal Javed & Amir Mosavi, 2021. "Systematic Review of Life Cycle Assessment and Life Cycle Cost Analysis for Pavement and a Case Study," Sustainability, MDPI, vol. 13(8), pages 1-38, April.
    6. Claudia Peters & Agnessa Kozak & Albert Nienhaus & Anja Schablon, 2020. "Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries—A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 17(2), pages 1-16, January.
    7. Sehee Kim & Mihyeon Park & Sukhee Ahn, 2022. "The Impact of Antepartum Depression and Postpartum Depression on Exclusive Breastfeeding: A Systematic Review and Meta-Analysis," Clinical Nursing Research, , vol. 31(5), pages 866-880, June.
    8. Yafei Shen & Weide Shao, 2022. "Influence of Hybrid Pedagogical Models on Learning Outcomes in Physical Education: A Systematic Literature Review," IJERPH, MDPI, vol. 19(15), pages 1-16, August.
    9. Nicola Andreij Rieg & Birgitta Gatersleben & Ian Christie, 2021. "Organizational Change Management for Sustainability in Higher Education Institutions: A Systematic Quantitative Literature Review," Sustainability, MDPI, vol. 13(13), pages 1-18, June.
    10. Alessandro Concari & Gerjo Kok & Pim Martens, 2020. "A Systematic Literature Review of Concepts and Factors Related to Pro-Environmental Consumer Behaviour in Relation to Waste Management Through an Interdisciplinary Approach," Sustainability, MDPI, vol. 12(11), pages 1-50, May.
    11. Mariam El Hourani & Gabriele Broll, 2021. "Soil Protection in Floodplains—A Review," Land, MDPI, vol. 10(2), pages 1-23, February.
    12. Kuangguo Zhou & Danmei Xu & Yang Cao & Jue Wang & Yunfan Yang & Mei Huang, 2014. "C-MYC Aberrations as Prognostic Factors in Diffuse Large B-cell Lymphoma: A Meta-Analysis of Epidemiological Studies," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    13. Lauralyn A McIntyre & David Moher & Dean A Fergusson & Katrina J Sullivan & Shirley H J Mei & Manoj Lalu & John Marshall & Malcolm Mcleod & Gilly Griffin & Jeremy Grimshaw & Alexis Turgeon & Marc T Av, 2016. "Efficacy of Mesenchymal Stromal Cell Therapy for Acute Lung Injury in Preclinical Animal Models: A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-16, January.
    14. Gill, Amy & Grace, Rebekah & Waniganayake, Manjula & Hadley, Fay, 2020. "Practitioner and foster carer perceptions of the support needs of young parents in and exiting out-of-home care: A systematic review," Children and Youth Services Review, Elsevier, vol. 108(C).
    15. Bin Wu & Haixiang Wu & Xiaoyan Liu & Houwen Lin & Jin Li, 2014. "Ranibizumab versus Bevacizumab for Ophthalmic Diseases Related to Neovascularisation: A Meta-Analysis of Randomised Controlled Trials," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-8, July.
    16. Konstantinos Katsanos & Panagiotis Kitrou & Stavros Spiliopoulos & Ioannis Maroulis & Theodore Petsas & Dimitris Karnabatidis, 2017. "Comparative effectiveness of different transarterial embolization therapies alone or in combination with local ablative or adjuvant systemic treatments for unresectable hepatocellular carcinoma: A net," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-31, September.
    17. Viktoria Maria Baumeister & Leonie Petra Kuen & Maike Bruckes & Gerhard Schewe, 2021. "The Relationship of Work-Related ICT Use With Well-being, Incorporating the Role of Resources and Demands: A Meta-Analysis," SAGE Open, , vol. 11(4), pages 21582440211, November.
    18. Felix A Achana & Alex J Sutton & Denise Kendrick & Persephone Wynn & Ben Young & David R Jones & Stephanie J Hubbard & Nicola J Cooper, 2015. "The Effectiveness of Different Interventions to Promote Poison Prevention Behaviours in Households with Children: A Network Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-18, April.
    19. Jing Chen & Tao Li & Qilun Liu & Haiyan Jiao & Wenjun Yang & Xiaoxia Liu & Zhenghao Huo, 2014. "Clinical and Prognostic Significance of HIF-1α, PTEN, CD44v6, and Survivin for Gastric Cancer: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-15, March.
    20. Johanna Weststrate & Geske Dijkstra & Jasper Eshuis & Alberto Gianoli & Maria Rusca, 2019. "The Sustainable Development Goal on Water and Sanitation: Learning from the Millennium Development Goals," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 143(2), pages 795-810, June.

    More about this item


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharme:v:39:y:2021:i:4:d:10.1007_s40273-020-00998-0. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.