Public Release: 

Child health costs for behavioral disorders similar to those for physical illnesses

Among behavioral disorders, anxiety and depression cost more

Children's Hospital of Philadelphia

Children with behavioral disorders incur similar overall health care costs to children with physical disorders according to a recent study. Among behavioral disorders, costs were not uniform; anxiety and depression cost twice as much as other common behavioral disorders, mainly as a result of inpatient hospitalizations. This study, by researchers from The Children's Hospital of Philadelphia and the University of Pennsylvania, appears in the electronic pages of the December issue of the journal Pediatrics.

"Examining healthcare costs, for children especially, is an increasingly important issue," said James P. Guevara, M.D., general pediatrician at The Children's Hospital of Philadelphia and primary investigator of this study. "This study shows that children with behavioral disorders incur similar healthcare costs to those with physical disorders, a recent observation which is important knowledge for the healthcare industry."

The retrospective cohort study looked at children ranging in age from 2 to 18 years old whose families participated in the 1996 Medical Expenditure Panel Survey. Children with common behavioral disorders were identified using diagnostic codes determined from household interviews. Researchers compared them to two control groups - healthy children and children with common chronic physical disorders such as asthma, epilepsy and diabetes.

Among the 3,955 eligible children, almost seven percent were identified with a behavioral disorder, including attention-deficit/hyperactivity disorder (ADHD), depression, anxiety, conduct disorder and oppositional-defiant disorder. Children with behavioral disorders incurred greater overall expenditures than healthy children ($1468 vs. $710), but costs were similar to those of children with physical disorders ($1468 vs. $1071). Children with behavioral disorders incurred greater expenditures for office-based visits and prescription medications than children in either control group.

Among children with behavioral disorders, children with depression and anxiety had double the overall expenditures for children with disruptive disorders - those that are apparent to others - such as attention-deficit/hyperactivity disorder (ADHD), conduct and oppositional-defiant disorders. This was mainly a result of increased hospitalization expenditures.

Much attention lately has focused on children's prescription medications, most specifically, on medications prescribed for children with behavioral disorders and psychiatric illness. Statistics show that prescriptions for children with psychiatric diseases and behavioral disorders are on the rise throughout the nation. This study highlights the costs of such medications to children with these disorders. This prescribing issue is pertinent to families of these children, prescribing physicians, and third-party providers that fund prescription medication. "Further study is also needed to determine reasons for higher hospitalization costs among children with depression and anxiety," said Dr. Guevara.


Study co-authors were Anthony L. Rostain, M.D., and Huaquing Zhao from The Children's Hospital of Philadelphia, and David S. Mandell, Sc.D., and Trevor R. Hadley, Ph.D., of the University of Pennsylvania.

Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked in 2003 as the best pediatric hospital in the nation by U.S.News & World Report and Child magazines. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding among children's hospitals. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19. Children's Hospital operates the largest pediatric healthcare system in the U.S. with more than 40 locations in Pennsylvania, New Jersey and Delaware.

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