Abstract
BackgroundAttention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families.ObjectiveA retrospective, propensity score-matched cohort study compared treatment patterns, healthcare resource utilization (HRU) and costs among children/adolescents with ADHD aged 6–17 years at treatment initiation (index) in Germany who received atomoxetine (ATX) or long-acting methylphenidate (LA-MPH) monotherapy.MethodsPatients received at least one prescription for their index medication (ATX/LA-MPH) during 2006–2010; the first prescription marked the index date. ATX- and LA-MPH-indexed cohorts were matched 1:1 (n = 737); a patient subset was identified that had not received ADHD-indicated medications in 12 months prior to index (novel initiators: ATX, n = 486; LA-MPH, n = 488). Treatment patterns were evaluated among novel initiators, and HRU and costs among the matched cohorts in the 12 months after index.ResultsNo significant differences in baseline characteristics were found between the novel initiator patient subsets. ATX-indexed novel initiators had significantly longer persistence to index medication [mean (standard deviation; SD) days: 222.0 (133.9) vs 203.2 (135.0), P = 0.029) but higher switching rates (8.8 vs 5.5 %, P = 0.045) than LA-MPH-indexed novel initiators. The total ATX-indexed cohort required more prescriptions [any medication; mean (SD): 20.9 (11.5) vs 15.7 (9.0), P < 0.001] and outpatient visits [mean (SD): 10.1 (6.3) vs 8.3 (5.3), P < 0.001], and incurred significantly higher total median healthcare costs (€1144 vs €541, P < 0.001) versus matched LA-MPH patients.ConclusionsThese real-world data indicate that, among children/adolescents with ADHD in Germany, ATX-indexed patients may require more prescriptions and physician visits, and incur higher total healthcare costs, than matched LA-MPH patients.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neurobehavioural disorder with core symptoms of inattention, hyperactivity and impulsivity [1]
We identified a subset of patients from each of the matched treatment cohorts who had not received any ADHD-indicated medications (ATX, long-acting methylphenidate (LA-MPH) or SA-MPH) during the 12-month baseline period
The ATX-indexed cohort had a higher proportion of patients who were ADHD-indicated medication-naıve than did the LA-MPH-indexed cohort [764/1174 (65.1%) vs 2134/3531 (60.4%), P = 0.005], but a lower proportion
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neurobehavioural disorder with core symptoms of inattention, hyperactivity and impulsivity [1]. ADHD often persists into adolescence and adulthood, and negatively influences academic, behavioural, emotional and social functioning [1, 2]. Psychiatric comorbidities are frequently present [3]. The management of ADHD in Germany involves nonpharmacological interventions such as behavioural therapy followed by pharmacotherapy [4]. The use of pharmacotherapy versus no treatment or behavioural therapy in children and adolescents with ADHD is cost-effective from a societal perspective [5]. One-half of the children/adolescents diagnosed with ADHD in Germany receive pharmacotherapy [6]. Attention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families
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