Cost of ADHD treatment using methylphenidate and atomoxetine in the South African private healthcare sector.

Introduction: The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) has risen over the last two decades, with a corresponding increase in the cost of its medication. Drug utilization studies in South Africa focusing on ADHD are limited.Areas covered: The primary aim was to determine the cost of methylphenidate and atomoxetine (used for ADHD). The Intercontinental Marketing Service (IMS) database which contains data of the private healthcare sector was interrogated from 2013 to 2016 (48-month period) focussing on methylphenidate and atomoxetine. Drug consumption was expressed in number of DDDs, DDDs/1000 inhabitants/day and cost in Rands.Expert opinion: Methylphenidate-containing products constituted a considerably higher percentage of the market share when compared to atomoxetine (90.30% versus 9.70%). The DDD/1000 inhabitants/day for methylphenidate was 6.010 with an annual cost for R266 691 778 in 2013, which increased to 7.827 DDDs/1000 inhabitants/day with an annual cost of R436 041 506 in 2016. Consumption of both methylphenidate and atomoxetine increased from 2013 to 2016. There was a preference for long-acting extended-release methylphenidate tablets even though the unit costs were higher when compared to the short-acting formulations. Despite increases in unit costs, the spend in South Africa showed an upward trend for methylphenidate and atomoxetine.

Evaluation of racial and socioeconomic disparities in medication pricing and pharmacy access and services.

PURPOSE: Results of a study to determine if disparities in drug pricing, pharmacy services, and community pharmacy access exist in a Tennessee county with a predominantly minority population are reported. METHODS: A cross-sectional survey of community pharmacies in Shelby County, a jurisdiction with a total population more than 60% composed of racial and ethnic minority groups, was conducted. Data collection included "out-of-pocket" (i.e., cash purchase) prices for generic levothyroxine, methylphenidate, and hydrocodone-acetaminophen; pharmacy hours of operation; availability of selected pharmacy services; and ZIP code-level data on demographics and crime risk. Analysis of variance, chi-square testing, correlational analysis, and data mapping were performed. RESULTS: Survey data were obtained from 90 pharmacies in 25 of the county's 33 residential ZIP code areas. Areas with fewer pharmacies per 10,000 residents tended to have a higher percentage of minority residents (p = 0.031). Methylphenidate pricing was typically lower in areas with lower employment rates (p = 0.027). Availability of home medication delivery service correlated with income level (p = 0.015), employment rate (p = 0.022), and crime risk (p = 0.014). CONCLUSION: A survey of community pharmacies in Shelby County, Tennessee, found that areas with a high percentage of minority residents had lower pharmacy density than areas with a high percentage of white residents. Pharmacies located in communities with low average income levels, low employment rates, and high scores for personal crime risk were less likely to offer home medication delivery services.

Comparative treatment patterns, healthcare resource utilization and costs of atomoxetine and long-acting methylphenidate among children and adolescents with attention-deficit/hyperactivity disorder in Germany.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families. OBJECTIVE: A 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. METHODS: Patients 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. RESULTS: No 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. CONCLUSIONS: These 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.

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

Comparative Cost Analysis of Sequential, Adaptive, Behavioral, Pharmacological, and Combined Treatments for Childhood ADHD.

We conducted a cost analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment, randomized, and adaptive trial investigating the sequencing and enhancement of treatment for children with attention deficit hyperactivity disorder (ADHD; Pelham et al., 201X; N = 146, 76% male, 80% Caucasian). The quantity of resources expended on each child's treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Beginning treatment with a low-dose/intensity regimen of behavior modification (large-group parent training) was less costly for a school year of treatment ($961) than beginning treatment with a low dose of stimulant medication ($1,669), regardless of whether the initial treatment was intensified with a higher "dose" or if the other modality was added. Outcome data from the parent study (Pelham et al., 201X) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings suggest that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD.

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil.

OBJECTIVE: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. METHOD: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. RESULTS: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. DISCUSSION: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. TRIAL REGISTRATION NUMBER: NCT01705613.

Recent Trends in Stimulant Usage.

OBJECTIVE: In the last decade, dramatic changes have occurred in stimulant medication prevalence and in patterns of stimulant treatment. The resultant trends merit analysis. METHOD: Usage patterns of stimulant medication, specifically amphetamine and methylphenidate, were analyzed for trends. The data were obtained from datasets including pharmacy claims, aggregate production quotas, bulk distribution to counties, pharmacy prescription sales, parent surveys, and physician visit surveys. Stimulant medication trends were organized by drug subclass, year, age group, gender, country, prescriber specialty, diagnosis, and expenditures. RESULTS: Major recent trends are as follows: amphetamine medication usage has prominently surpassed methylphenidate, total stimulant prescription sales to adults have surpassed those for youth, and more adult women are prescribed stimulants than adult men. CONCLUSION: Stimulant medication treatment-particularly of amphetamines-is rapidly expanding in the United States. Off-label use is reported to be at least 40% of total use and appears to be more common in adults. (J. of Att. Dis. 2016; 20(6) 471-477).

Psychostimulant prescribing trends in a paediatric population in Ireland: a national cohort study.

BACKGROUND: Psychotropic paediatric prescribing trends are increasing internationally. The aim of this study is to examine the prevalence and secular trends in psychotropic prescribing in Irish children and adolescents between 2002 and 2011. METHODS: Data was obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive Primary Care Reimbursement Services (HSE-PCRS). Prescribing rates per 1000 eligible population and associated 95% confidence intervals (CIs) were calculated across years (2002-2011), age groups (0-4, 5-11, 12-15 years) and gender. Rates of concomitant prescriptions for psycholeptics and antidepressants were also examined. The total expenditure costs were calculated and expressed as a percentage of the cost of all prescriptions for this age group (≤ 15 years). RESULTS: In 2002, 3.77/1000 GMS population (95% CI: 3.53-4.01) received at least one psychostimulant prescription and this rate increased to 8.63/1000 GMS population (95% CI: 8.34-8.92) in 2011. Methylphenidate was the most frequently prescribed psychostimulant. For both males and females the prevalence of medication use was highest among the 12-15 year old group. On average, a psycholeptic medication was prescribed to 8% of all psychostimulant users and an antidepressant was concomitantly prescribed on average to 2%. Total expenditure rose from €89,254 in 2002 to €1,532,016 in 2011. CONCLUSIONS: The rate and cost of psychostimulant prescribing among GMS children and adolescents in Ireland increased significantly between 2002 and 2011. Further research is necessary to assess the safety, efficacy and economic impact of concomitant psychotropic prescribing in this population.

Ethylphenidate: availability, patterns of use, and acute effects of this novel psychoactive substance.

PURPOSE: Ethylphenidate is a novel psychoactive substance that is an analogue of methylphenidate. This paper describes its availability, patterns of use, and acute effects. METHODS: Searches of the scientific and grey literature (publicly accessible Internet resources) were undertaken, using the keywords "Ethylphenidate", "Ethyl phenidate", "Ethyl phenyl(piperidin-2-yl)acetate", and "Nopaine", to identify information on the prevalence and patterns of use, desired effects, and toxicity of ethylphenidate. An Internet snapshot survey was performed on 10 February 2015 to provide information on availability and cost of ethylphenidate. RESULTS: The literature search identified 1 case series of acute recreational ethylphenidate toxicity, 1 case report of ethylphenidate dependence, 1 qualitative analysis of user reports on Internet drug forums, 2 conference abstracts for surveillance studies, 1 report of two cases of ethylphenidate detected in post-mortem analyses, and 198 user reports on Internet discussion forums and social media sites. The Internet snapshot survey found 83 websites selling ethylphenidate, with purchase prices ranging from £28.20 ± 0.63 (€37.71 ± 0.85) per gram for a 500-mg amount to £2.64 ± 0.57 (€3.53 ± 0.77) per gram for 1 kg. The published cases and Internet user reports suggest the acute effects of ethylphenidate are similar to other stimulant drugs; the most common route of use was by nasal insufflation. The most common desired effects were euphoria, stimulation, and increased concentration, sociability, and energy levels; the most common unwanted effects included anxiety, palpitations, insomnia, and paranoia. CONCLUSION: This review of the scientific and grey literature has demonstrated that the acute harms associated with its use are stimulant in nature and that ethylphenidate is widely available to users over the Internet, with significant discounts for bulk purchases.

Trends in attention-deficit/hyperactivity disorder drug consumption in children and adolescents in Slovenia from 2001 to 2012: a drug use study from a national perspective.

OBJECTIVE: In most Eastern and Central European countries, except Germany, there is a lack of drug consumption studies for attention-deficit/hyperactivity disorder (ADHD). The main purpose of the present study was to present the pattern and the evolution of national ADHD drug consumption in Slovenia. METHODS: The national consumption data for the period 2001-2012 and medication costs were obtained from the database of the Health Insurance Institute of Slovenia. A defined daily dose (DDD) per 1000 inhabitants per day and the total medication cost in euro were extracted. Only immediate-release methylphenidate (IR-MPH), methylphenidate-osmotic release oral delivery system (OROS-MPH) and atomoxetine (ATX) have been approved for ADHD in Slovenia and are included in this study. Amphetamines have not been available in Slovenia. RESULTS: ADHD drug consumption increased in Slovenia from 0.0537 DDD/1000 inhabitants/day in 2001 to 0.0687 DDD/1000 inhabitants/day in 2006 and to 0.3076 DDD/1000 inhabitants/day in 2012. The rise was largely because of an increase in OROS-MPH consumption and increase in ATX consumption, whereas the consumption of IR-MPH decreased rapidly. During the study period, the total cost of the medicines increased 31-fold. From 2007 to 2010, the total cost of ADHD medicines increased 14-fold and from 2010 to 2012 the cost increased by 11.4% only. CONCLUSIONS: When new drugs are licensed in a jurisdiction, their prescription rates increase rapidly. The changes in the pattern of prescribing medicines are evident in Slovenia, primarily in the increase of OROS-MPH and ATX prescriptions and in the rapid decrease of IR-MPH prescriptions. Results indicate a need for appropriate interventions in Slovenia.

The Brazilian policy of withholding treatment for ADHD is probably increasing health and social costs.

OBJECTIVE: To estimate the economic consequences of the current Brazilian government policy for attention-deficit/hyperactivity disorder (ADHD) treatment and how much the country would save if treatment with immediate-release methylphenidate (MPH-IR), as suggested by the World Health Organization (WHO), was offered to patients with ADHD. METHOD: Based on conservative previous analyses, we assumed that 257,662 patients aged 5 to 19 years are not receiving ADHD treatment in Brazil. We estimated the direct costs and savings of treating and not treating ADHD on the basis of the following data: a) spending on ADHD patients directly attributable to grade retention and emergency department visits; and b) savings due to impact of ADHD treatment on these outcomes. RESULTS: Considering outcomes for which data on the impact of MPH-IR treatment are available, Brazil is probably wasting approximately R$ 1.841 billion/year on the direct consequences of not treating ADHD in this age range alone. On the other hand, treating ADHD in accordance with WHO recommendations would save approximately R$ 1.163 billion/year. CONCLUSIONS: By increasing investments on MPH-IR treatment for ADHD to around R$ 377 million/year, the country would save approximately 3.1 times more than is currently spent on the consequences of not treating ADHD in patients aged 5 to 19 years.

Probabilistic Markov Model Estimating Cost Effectiveness of Methylphenidate Osmotic-Release Oral System Versus Immediate-Release Methylphenidate in Children and Adolescents: Which Information is Needed?

BACKGROUND: Incidence of attention deficit hyperactivity disorder (ADHD) in children and adolescents has been increasing. The disorder results in high societal costs. Policymakers increasingly use health economic evaluations to inform decisions on competing treatments of ADHD. Yet, health economic evaluations of first-choice medication of ADHD in children and adolescents are scarce and generally do not include broader societal effects. OBJECTIVES: This study presents a probabilistic model and analysis of methylphenidate osmotic-release oral system (OROS) versus methylphenidate immediate-release (IR). We investigate and include relevant societal aspects in the analysis so as to provide cost-effectiveness estimates based on a broad societal perspective. METHODS: We enhanced an existing Markov model and determined the cost effectiveness of OROS versus IR for children and adolescents responding suboptimally to treatment with IR. Enhancements included screening of a broad literature base, updated utility values, inclusion of costs and effects on caregivers and a change of the model type from deterministic to probabilistic. RESULTS: The base case scenario resulted in lower incremental costs (€-5815) of OROS compared with IR and higher incremental quality-adjusted life-year (QALY) gains (0.22). Scenario analyses were performed to determine sensitivity to changes in transition rates, utility of caregivers, medical costs of caregivers and daily medication dose. CONCLUSIONS: The results indicate that, for children responding suboptimally to treatment with IR, the beneficial effect of OROS on compliance may be worth the additional costs of medication. The presented model adds to the health economic information available for policymakers and to considerations on a broader perspective in cost-effectiveness analyses.

Psychostimulants for managing unipolar and bipolar treatment-resistant melancholic depression: a medium-term evaluation of cost benefits.

BACKGROUND: We earlier reported an open study of 50 unipolar and bipolar treatment resistant depressed patients indicating that psychostimulants may have differential superiority for the melancholic depressive sub-type. We designed an extension study to examine cost benefits of psychostimulants more closely for those only with melancholic depression. METHOD: The sample comprised patients clinically diagnosed with melancholic depression who had failed to respond to and/or experienced significant side-effects with at least two antidepressants. Data were collected for 61 unipolar and 51 bipolar II patients receiving a psyschostimulant for a mean interval of 69 weeks. Benefits and side-effects were assessed. RESULTS: Effectiveness ratings were similar across unipolar and bipolar sub-sets. Psychostimulants were judged as 'very' effective for 20% of patients and 'somewhat' effective for 50%. Forty percent judged the psychostimulant as being 'as effective' or as 'superior' to previously prescribed antidepressants, and worthy of being maintained. Significant side-effects were experienced by 40% of patients, requiring medication to be ceased in 12%. Twenty percent of the bipolar patients experienced a worsening of highs. LIMITATIONS: The study was uncontrolled and retrospective, no formal rater-completed or patient-completed interval measures of severity were completed, while diagnostic judgments about melancholic depression and bipolar disorder were clinically judged. CONCLUSIONS: This open study suggests that psychostimulants may be efficacious antidepressant options for managing unipolar and bipolar melancholia, often seemingly having very rapid onset and generally requiring only low doses, and arguing the need for controlled studies in melancholic patients.

Descriptive comparison of drug treatment-persistent, -nonpersistent, and nondrug treatment patients with newly diagnosed attention deficit/hyperactivity disorder in Germany.

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous behavioral disorder commonly found in children, with serious lifetime health and social consequences for both children and their parents. Public awareness of ADHD in Germany has increased in the past decade, but little is known about the costs of treating newly diagnosed patients in clinical practice. OBJECTIVE: This study aimed to describe the resource utilization and treatment costs of patients aged 6 to 17 years with newly diagnosed ADHD, using patient data from a German sickness fund, and to quantify resource utilization by drug treatment and treatment persistence. METHODS: To identify patients with newly diagnosed ADHD, the second largest German sickness fund was utilized. Complete claims data of all de-identified patients meeting eligibility criteria for 2007 and 2008 were extracted. Patients were divided into 1 of 3 treatment groups: drug treatment-persistent, drug treatment-nonpersistent, and nondrug treatment. The differences in costs and resource utilization are reported in a descriptive manner, with paired and unpaired 2-sample Wilcoxon tests used. RESULTS: Of 3407 newly diagnosed patients with ADHD, 1105 (32%) received an ADHD-specific drug following diagnosis; the remaining 2302 comprised the nondrug treatment group. Of the total number of drug-treated patients, 1-year observational data were available for only 786 methylphenidate users (71%). Of these, 503 patients (64%) comprised the drug treatment-persistent group (those having at least 1 prescription every 3 months during the 12 months following their first ADHD prescription) and 283 (36%) comprised the drug treatment-nonpersistent group. After excluding those patients with <12 months of follow-up, 1779 patients (52%) were included in the nondrug-treatment group. Outpatient visits and the number of drug prescriptions and associated costs were highest in the drug treatment-persistent group (P = 0.05); however, the number of hospital admissions and days spent in-hospital were lowest in this group. Significant average savings of €347/y in overall costs(P » 0.05) were noted for the drug treatment­persistent group compared with the drug treatment­non persistent group. Nondrug-treated patients had €181/y lower costs (P » 0.05) comparedtodrugtreatment-persistentgroup.Drugtreatment-nonpersistentpatientswerethemost expensive group [corrected]. These mean savings were €739/y and €552/y (drug treatment-persistent group and drug treatment-nonpersistent group, respectively) compared with nondrug-treated patients. CONCLUSIONS: There are potential cost-savings benefits when patients are treatment persistent compared to nonpersistent [corrected]. Therefore, future disease-management programs might consider treatment persistence as potentially reducing overall payer costs. Additionally, the clinical and psychosocial situations of patients and their families should be taken into account.

Comparison of prescription drug costs in the United States and the United Kingdom, part 3: methylphenidate.

STUDY OBJECTIVE: To compare the annual cost of methylphenidate in the United States and the United Kingdom. DESIGN: Matched-cohort cost analysis. DATA SOURCES: The U.K. General Practice Research Database (GPRD) and MarketScan Commercial Claims and Encounters Database, a large, U.S. self-insured medical claims database. STUDY POPULATION: We initially identified 1.6 million people in the GPRD who were younger than 65 years of age in 2005. These people were then matched by year of birth and sex with 1.6 million people in the U.S. database. From this matched pool, we estimated that 98,000 boys aged 5-14 years from each country in 2005 were prescribed at least one drug. Of these, 6485 (6.6%) in the U.S. were prescribed methylphenidate compared with 1405 (1.4%) in the U.K. After excluding those who did not receive methylphenidate continuously, there remained 2298 boys in the U.S. and 939 in the U.K. who were prescribed methylphenidate continuously during 2005 (annual methylphenidate users). We estimated and compared drug costs (presented in 2005 U.S. dollars) for continuous users separately in the two countries. MEASUREMENTS AND MAIN RESULTS: Estimated drug costs were determined by random sampling. Estimated annual costs/patient in the U.S. ranged from $402 for doses of 5-10 mg to $821 for doses greater than 20 mg. In the U.K., costs ranged from $146 for doses of 5-10 mg to $661 for doses greater than 20 mg. The total annual cost of the continuous receipt of methylphenidate in the U.S. was $170,199 compared with $39,393 in the U.K. CONCLUSION: The cost of methylphenidate for boys aged 5-14 years paid by private insurance companies in the U.S. was more than 4 times higher than comparable costs paid by the government in the U.K.

Identifying patient subgroups who benefit most from a treatment: using administrative claims data to uncover treatment heterogeneity.

OBJECTIVES: To illustrate how claims data can be used to (1) develop outcome scores that predict response to a traditional treatment and (2) estimate the economic impact of individualized assignment to a newer treatment based on the outcome score. An example application is based on two treatments for attention deficit hyperactivity disorder (ADHD): osmotic-release oral system methylphenidate (OROS-MPH) and lisdexamfetamine dimesylate (LDX). METHODS: Adolescents with ADHD initiating OROS-MPH (n=6320) or LDX (n=6394) were selected from the MarketScan claims database. A model was developed for predicting risk of switching/augmentation with OROS-MPH using multiple baseline characteristics. The model was applied to an independent sample to stratify patients by their predicted risk and, within each stratum, risk of switching/augmentation and ADHD-related total costs were compared between OROS-MPH and LDX patients using inverse probability of treatment weighting. RESULTS: The prediction model resulted in substantial stratification, showing risk of switching/augmentation with OROS-MPH ranging from 11.3-42.1%. In the two strata where OROS-MPH had highest risk of switching/augmentation, LDX had significantly lower risk of switching/augmentation than OROS-MPH (by 7.0-8.2%) and lower ADHD-related annual total costs (by $264-$625 per patient). LIMITATIONS: The current study has used the risk of switching/augmentation as a proxy measure for treatment efficacy to establish the prediction model. Future research using a clinical measure for ADHD symptoms is warranted to verify the findings. CONCLUSIONS: Combining multiple patient characteristics into a predicted score for treatment outcomes with a traditional treatment can help identify subgroups of patients who benefit most from a new treatment. In this analysis, ADHD patients with a high predicted score for switching/augmentation with OROS-MPH had a lower rate of switching/augmentation with LDX. Assigning OROS-MPH and LDX treatments based on the predicted scores that are heterogeneous in a patient population may help improve clinical outcomes and the cost-effectiveness of care.

Trends in the consumption of attention deficit hyperactivity disorder medications in Castilla y León (Spain): changes in the consumption pattern following the introduction of extended release methylphenidate.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is the most diagnosed behavioural disorder in children and adolescents; prevalence has been estimated around 5%. Studies have shown an increase in the use of ADHD medications during the last years. The aim of the present study was to learn the pattern and the evolution of ADHD medication consumption in Castilla y León (Spain). METHOD: Consumption data for the period 1992-2009 were obtained from databases containing information upon consumption and cost of medications dispensed by pharmacies at the expense of the Spanish National Health System. The data were expressed in defined daily doses (DDDs) per 1000 inhabitants per day (DDD/1000 inhabitants/day). A model to forecast consumption was built. RESULTS: Attention deficit hyperactivity disorder medication consumption increased in Castilla y León from 0.1 DDD/1000 inhabitants/day in 1992 to 1.5 DDD/1000 inhabitants/day in 2009; expected consumption will reach 2.5 DDD/1000 inhabitants/day by 2013. The drugs accounting for this increase were mainly made up of methylphenidate preparations (1.4 DDD/1000 inhabitants/day in 2009). From 1992 to 1999, there was a slight reduction in methylphenidate use; following amphetamine withdrawal, the consumption of stimulants began to increase, and figures showed a sharp rise after marketing of extended-release formulations in 2003. CONCLUSIONS: There has been an enormous increase in ADHD medication consumption in Castilla y León in the last few years; increase rocketed when extended-release methylphenidate was marketed. A rapid increase in the consumption is a warning on possible overdiagnosis and inappropriate prescription.