Impact of methylphenidate formulation on treatment patterns and hospitalizations: a retrospective analysis.

Jason E Kemner,Maureen J Lage

doi:10.1186/1744-859x-5-5

Jason E Kemner, Maureen J Lage

Open Access

https://doi.org/10.1186/1744-859x-5-5

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Abstract

BackgroundWhile stimulant therapy has been shown to be effective in the treatment of attention-deficit/hyperactivity disorder (ADHD), there is less information concerning differences between alternative stimulant medications. The purpose of this study is to examine how different formulations of methylphenidate (MPH) affect treatment patterns and hospitalizations.MethodsFrom a large claims database we retrospectively identified individuals age 6 or older who were diagnosed with ADHD and who received either once daily, extended-release oral system methylphenidate (OROS® MPH) (e.g., Concerta®) or three-times daily immediate-release generic methylphenidate (TID MPH). There were 5,939 individuals included in the analysis – 4,785 who initiated therapy with OROS MPH and 1,154 who initiated therapy with TID MPH. We used Analyses of Covariance (ANCOVAs) to examine differences in treatment patterns between individuals who initiated therapy on OROS MPH and those who initiated therapy on TID MPH. We used logistic and negative binomial multivariate regressions to examine the probability of being hospitalized and the hospital length of stay.ResultsControlling for demographic characteristics, patient general health status, and comorbid diagnoses, significantly fewer individuals who initiated therapy with OROS MPH had a 15-day gap in therapy (85% vs. 97%, p < 0.0001 or a 30-day gap in therapy (77% vs. 95%, p < 0.0001) or switched to another ADHD medication (27% vs. 68%, p < 0.0001). Individuals who initiated therapy with OROS MPH stayed on therapy significantly longer (199 vs. 108 mean days, p < 0.0001) and more individuals received medication for 90% (24% vs. 5%, p < 0.0001), 80% (29% vs. 7%, p < 0.0001), or 75% (30% vs. 7%, p < 0.0001) of the days during the first year post initiation of therapy. Individuals who initiated therapy on OROS MPH were also significantly less likely to be hospitalized (odds ratio = 0.67, p = 0.0454) and stayed, on average, 0.69 fewer days in the hospital (p = 0.0035).ConclusionResults demonstrate that among individuals diagnosed with ADHD who receive either OROS MPH or TID MPH, the use of OROS MPH is associated with fewer gaps in medication, less switches in medication, and more days on intent-to-treat therapy. In addition, use of OROS MPH compared to TID MPH was associated with improved outcomes, as measured by the reduced use of hospitalizations.

Highlights

While stimulant therapy has been shown to be effective in the treatment of attention-deficit/hyperactivity disorder (ADHD), there is less information concerning differences between alternative stimulant medications
Patients were eligible for inclusion in the analysis if they received a diagnosis of ADHD based upon International Classification of Diseases, Ninth Revision (ICD-9) codes of 314.00 or 314.01, and received either OROS MPH or times daily immediate-release generic methylphenidate (TID MPH)
The results of the multivariate regression analyses demonstrate that ADHD patients treated with OROS MPH are more likely to experience longer treatment periods than patients treated with TID MPH, but are significantly less likely to experience a gap in switch in therapy

Summary

Introduction

While stimulant therapy has been shown to be effective in the treatment of attention-deficit/hyperactivity disorder (ADHD), there is less information concerning differences between alternative stimulant medications. ADHD is one of the most frequently diagnosed childhood mental health conditions, with a prevalence of 8–10% in school age children[1]. Children diagnosed with ADHD can suffer from academic impairments, social dysfunction, and a higher risk of both cigarette smoking and substance abuse [2,3]. As with the childhood population, there are significant costs associated with ADHD in the adult population. Adults with ADHD have been found to have larger medical costs [10] , less education [11] and higher rates of incarceration [12]. Adults with ADHD are less likely to be employed [13,14] , while those employed are more likely to perform poorly, change employment, or quit their jobs [15,16]

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