title: Emergency department use and costs for youth with attention-deficit/hyperactivity disorder: associations with stimulant treatment.
abstract: OBJECTIVE
  To investigate whether, among youth with attention-deficit/hyperactivity disorder (ADHD), stimulant treatment is associated with reduced emergency department (ED) use and medical costs.
  
  
  METHODS
  We previously reviewed the complete and detailed school and medical records of all individuals born 1976-1982 in Rochester, Minn, to identify those who met criteria for ADHD between age 5 years and emigration from the area. Stimulant treatment (all start/stop dates, dosages) was also abstracted. This study followed birth cohort members with ADHD in provider-linked billing data from January 1, 1987 (billing data first available), to age 18 for outcomes: ED visits, ED costs, and medical costs. For each outcome, we analyzed associations with 1) any stimulants (yes/no), 2) proportion of follow-up time on stimulants, and 3) among those treated with stimulants, periods on versus off stimulants.
  
  
  RESULTS
  Of 313 youth with ADHD, 231 (74%) received any stimulants; treatment duration ranged from 14 days to 11.8 years. Treated and untreated youth were similar with respect to median annual ED visits (0.5 vs 0.5) and medical costs (661 US dollars vs 741 US dollars) (P > .05); however, increasing proportion of follow-up on stimulants was associated with fewer ED visits (P= .02) and higher medical costs (P< .001). The 231 treated youth experienced an average of 3.7 periods on and off stimulants; while receiving stimulants, they exhibited fewer ED visits (P= .02), lower ED costs (P = .03), and higher medical costs (P< .001) compared with periods off stimulants.
  
  
  CONCLUSIONS
  Among youth with ADHD, extended stimulant treatment is associated with decreased ED visits and ED costs, but higher total medical costs.
authors.affiliation: Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. leibson@mayo.edu
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Leibson
authors.forename: William J
authors.initials: WJ
authors.lastname: Barbaresi
authors.forename: Jeanine
authors.initials: J
authors.lastname: Ransom
authors.forename: Robert C
authors.initials: RC
authors.lastname: Colligan
authors.forename: Jason
authors.initials: J
authors.lastname: Kemner
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Slavica K
authors.initials: SK
authors.lastname: Katusic
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics; D000697:Central Nervous System Stimulants / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006801:Humans; D012189:Retrospective Studies
chemical_list: D000697:Central Nervous System Stimulants