Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 16, Issue 1, 2013. Pages: 27-33
Published Online: 1 March 2013

The Fiscal Consequences of ADHD in Germany: A Quantitative Analysis Based on Differences in Educational Attainment and Lifetime Earnings

Nikolaos Kotsopoulos,¹ Mark P. Connolly,¹ Esther Sobanski,² Maarten J. Postma³

¹Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, The Netherlands and Global Market Access Solutions, Mooresville NC, USA
²Central Institute of Mental Health Mannheim, Department of Psychiatry & Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
³Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, The Netherlands

* Correspondence to: Global Market Access Solutions LLC, Mooresville, NC, 2811, USA
Tel.: +1-704-677 3010
Fax: +1-704-677 3010
E-mail: n.kotsopoulos@rug.nl

Source of Funding: The work described here was conducted to fulfil doctoral requirements for Nikolaos Kotsopoulos. The work conducted by Nikolaos Kotsopoulos and Dr. Mark Connolly was supported by a grant from Shire Pharmaceuticals in Switzerland. The other authors declare no conflicts of interest in relation to the work described here and hold no shares in the sponsoring organisation. PD Dr. E. Sobanski and Professor M.J. Postma received no financial remuneration for their scientific contributions to this work. Esther Sobanski is a member of scientific advisory boards for Eli Lilly, Medice, Shire, and Janssen-Cilag. Shire Pharmaceuticals reviewed and edited the manuscript for scientific accuracy. Although Shire Pharmaceuticals was involved in the topic concept and fact checking of information, the content of this manuscript, the ultimate interpretation, and the decision to submit it for publication in Journal of Mental Health Policy and Economics was made by the authors independently.

Abstract

This research estimated the long-term fiscal consequences of attention deficit hyperactivity disorder (ADHD) on the German government and social insurance system based on differences in educational attainment and lifetime earnings. Differences in educational attainment between ADHD and non-ADHD cohorts were linked to education-specific earnings. Direct and indirect tax rates and social insurance contributions were linked to differences in lifetime, education-specific earnings. The lifetime net tax revenue for a non-ADHD individual was approximately €80,000 higher compared to an untreated ADHD individual. The discounted fiscal burden of an untreated ADHD cohort (n=31,844) was estimated at €2.5 billion in the year 2010. The findings suggest that ADHD results in long-term financial loss due to lower education attainment and lifetime reduced earnings thus, investments in ADHD interventions allowing more children to achieve their educational potential may offer fiscal benefits.

Objective: To estimate the long-term fiscal consequences of attention deficit hyperactivity disorder (ADHD) on the German government and social insurance system based on differences in educational attainment and the resulting differences in lifetime earnings compared with non-ADHD cohorts.

Methods: Differences in educational attainment between ADHD and non-ADHD cohorts were linked to education-specific earnings data. Direct and indirect tax rates and social insurance contributions were linked to differences in lifetime, education-specific earnings to derive lost tax revenue in Germany associated with ADHD. For ADHD and non-ADHD cohorts we derived the age-specific discounted net taxes paid by deducting lifetime transfers from lifetime gross taxes paid.

Results: The lifetime net tax revenue for a non-ADHD individual was approximately € 80,000 higher compared to an untreated ADHD individual. The fiscal burden of untreated ADHD, based on a cohort of n=31,844 born in 2010, was estimated at € 2.5 billion in net tax revenue losses compared with an equally-sized non-ADHD cohort. ADHD interventions providing a small improvement in educational attainment resulted in fiscal benefits from increases in lifetime tax gains.

Conclusions: ADHD results in long-term financial loss due to lower education attainment and lifetime reduced earnings and resulting lifetime taxes and social contributions paid. Investments in ADHD interventions allowing more children to achieve their educational potential may offer fiscal benefits generating a positive rate of return.

Received 24 May 2012; accepted 13 January 2013