3. Impact on individual physicians
These projections have been related to individual German physicians involved in care for children and adolescents with ADHD. Since ADHD care is a highly concentrated phenomenon (cf. Table 2), average spending (again, from the perspective of the GKV) for ADHD pharmacotherapy was calculated for the top-50% of child and adolescent psychiatrists, and the top-20% of pediatricians (see Figure 5).
Figure 5  Projected impact of ADHD treatment for children and adolescents on individual physicians' prescription drug expenditures, 2001–2012 (base case). a: Child and adolescent psychiatrists; b: pediatricians in private practice in Germany. Expenditures expressed as €/physician and year; perspective of statutory health insurance (i.e., excluding privately health insured patients). Data represent average values for one of the upper 50% of child and adolescent psychiatrists and one of the upper 20% of pediatricians in terms of relative involvement in care for ADHD patients, respectively. Concentration of care modeled according to Nordbaden data [74]. Abbreviation: Non-ADHD-Rx: expenditures for treatment of conditions other than ADHD.   Under base case assumptions, total annual drug spending of these child and adolescent psychiatrists would grow from an average total of less than €30,000 per physician in 2002 to €282,000 in 2012, of which €264,000 would be caused by prescriptions for ADHD treatment in children and adolescents (Figure 5). (Of course, as adult patients with ADHD have not been included in this analysis, the total budgetary impact of ADHD may be greater for those specialists who also treat adults, for example parents of patients.) This almost tenfold increase is the result of (a) the projected ADHD spending in combination with (b) the high concentration of patients among a small total number of specialists and (c) the very small number of prescriptions traditionally written by this specialist group. Even for the extremely low case looked at, this overall increase of drug spending by individual physicians would result in >5-fold drug spending caused by these specialists in 2012, compared to 2002. In this most conservative scenario, €144,500 or 89% of projected expenditures of €162,600 per physician in 2012 would still be accounted for by young ADHD patients.
Pediatricians as a group cause higher drug expenditures, and each of them treats a smaller number of ADHD patients compared to specialists, even those who are among the top-20% service providers for children with ADHD among their group. Hence, the incremental impact of ADHD-related spending is smaller compared to child and adolescent psychiatrists (Figure 4). Still, under base case conditions, ADHD-related pharmaceutical expenditures would account for 39% (or €75,000 out of €193,000 per physician in 2012, assuming a 5% growth rate of non-ADHD pharmaceutical spending) of total drug costs induced by this group. These figures compare with average drug costs of €83,000 per pediatrician in 2002. Thus, ADHD-related prescriptions alone would account for two thirds of the growth in drug expenditures caused by these physicians between 2002 and 2012.