Treatment Patterns, Health Care Resource Utilization, and Health Care Cost Associated with Atypical Antipsychotics or Guanfacine Extended Release in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder in Quebec, Canada.

Jean Lachaine,Tamara Pringsheim,James Burns,Leila Ben Amor,Judy Van Stralen

doi:10.1089/cap.2019.0097

Abstract

Objective: To assess treatment patterns, health care resource utilization, and health care costs associated with use of atypical antipsychotics (AAPs) or the nonstimulant guanfacine extended release (GXR) after stimulant therapy for attention-deficit/hyperactivity disorder (ADHD). In Canada, GXR is approved as a monotherapy for children and adolescents with ADHD or as an adjunct to stimulants, and AAPs are commonly used off-label as an adjunct to stimulants.Methods: Health care claims data (January 1, 2007 to March 31, 2016) from Quebec's provincial health plan were assessed for individuals with ADHD, 6–17 years of age, who received ≥1 stimulant followed by a first AAP or GXR prescription (index medication), without a diagnosis for which AAPs are indicated.Results: Overall, 1327 individuals were included (AAPs, 1098; GXR, 229). Rates of discontinuation, augmentation, or switching of the index medication did not differ between AAPs and GXR during the first follow-up year. Discontinuation rates were significantly lower with GXR than with AAPs during the second year (22.0% vs. 35.9%; p = 0.03). GXR and AAPs resulted in similar increases in total health care cost. In GXR users, the increase in prescription drug cost after 6 months was higher than in AAP users, whereas the increase in overall medical cost was higher with AAPs than GXR, owing to more psychiatric department visits.Conclusions: In children and adolescents with ADHD who used AAPs or GXR after stimulants, secondary treatment changes were similar with both treatments after 1 year, but discontinuation rates were significantly lower with GXR than with AAPs in the second year. The greater increase in prescription cost with GXR was balanced by a greater increase in overall medical costs with AAPs, resulting in no overall difference in total health care cost between the two treatments.

Highlights

Attention-deficit/hyperactivity disorder (ADHD) is a common pediatric disorder associated with a considerable economic burden
In children and adolescents with attention-deficit/ hyperactivity disorder (ADHD) who used atypical antipsychotics (AAPs) or guanfacine extended release (GXR) after stimulants, secondary treatment changes were similar with both treatments after 1 year, but discontinuation rates were significantly lower with GXR than with AAPs in the second year
The type of stimulant most frequently used before the index treatment was MPH in the AAP group, and extended release (ER) amphetamine in the GXR group (Supplementary Table S1)

Summary

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a common pediatric disorder associated with a considerable economic burden. Attention Deficit Hyperactivity Disorder Resource Alliance [CADDRA] 2011); a considerable proportion of patients receiving stimulants change their regimen, owing to an inadequate response, dose-limiting side effects, comorbid disorders, or personal preferences (Arnold 2000; Stockl et al 2003; Elvanse Prescribing Information 2014; Equasym Prescribing Information 2014). Claims database studies from Canada and the USA have demonstrated that, among stimulant-treated children and adolescents with ADHD, the 1-year prevalence of medication switching or augmentation is 19%–23% (Ben Amor et al 2014; Betts et al 2014). Not approved for the treatment of ADHD, clonidine and atypical antipsychotics (AAPs) are commonly used off-label in ADHD, especially when stimulants fail

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