Off-label utilization of antihypertensive medications in children.
OBJECTIVE
To examine off-label use and costs of antihypertensive drugs in children by using a national sample of prescription claims.


METHODS
We conducted a cross-sectional study using the 2002 Medstat MarketScan Database, a national sample of outpatient prescription claims of children <or=18 years old enrolled in private, employer-sponsored health plans. Our main outcomes were off-label use of antihypertensive drugs by patient age and costs of antihypertensives calculated as mean cost per child per 30-day fill.


RESULTS
One half of the index antihypertensive prescription claims were off label, based on minimum age criteria. Boys were more likely (56%) than girls (46%) to be prescribed off-label antihypertensives (P < .001). Children aged >or=12 years were more likely to be prescribed off-label antihypertensives (53%) compared with children aged <or=5 (46%) and 6-11 years (42%; P < .001). Off-label use varied significantly by class of antihypertensive drugs (P < .001). Overall, off-label antihypertensives were significantly more expensive than on-label antihypertensives.


CONCLUSIONS
Despite availability of often less expensive on-label alternatives for the same class of antihypertensive drugs, off-label antihypertensive drugs were prescribed frequently in children. These findings underscore the potential clinical and economic implications of common off-label prescribing, for children, their parents, physicians, and payers.
Division of General Pediatrics, University of Michigan, Ann Arbor, MI 48109-0456, USA. est@med.umich.edu
Esther Y
EY
Yoon
Kevin J
KJ
Dombkowski
Albert
A
Rocchini
Jen-Jar
JJ
Lin
Matthew M
MM
Davis
D000293:Adolescent; D017677:Age Distribution; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004346:Drug Information Services; D004348:Drug Labeling; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007356:Insurance, Pharmaceutical Services; D016015:Logistic Models; D008297:Male; D017678:Sex Distribution; D014481:United States
D000959:Antihypertensive Agents