Medication use and spending trends among children with ADHD in Florida's Medicaid program, 1996-2005.
OBJECTIVE
How the introduction of new pharmaceuticals affects spending for treatment of children with attention-deficit hyperactivity disorder (ADHD) is unknown. This study examined trends in use of pharmaceuticals and their costs among children with ADHD from 1996 to 2005.


METHODS
This observational study used annual cohorts of children ages three to 17 with ADHD (N=107,486 unique individuals during the study period) from Florida Medicaid claims to examine ten-year trends in the predicted probability for medication use for children with ADHD with and without psychiatric comorbidities as well as mental health spending and its components. Additional outcome measures included average price per day and average number of days filled for medication classes.


RESULTS
Overall, the percentage of children with ADHD treated with ADHD drugs increased from 60% to 63%, and the percentage taking antipsychotics more than doubled, from 8% to 18%. In contrast, rates of antidepressant use declined from 21% to 15%, and alpha agonist use was constant, at 15%. Mental health spending increased 61%, with pharmaceutical spending representing the fastest-rising component (up 192%). Stimulant spending increased 157%, mostly because of increases in price per prescription. Antipsychotic spending increased 588% because of increases in both price and quantity (number of days used). By 2005, long-acting ADHD drugs accounted for over 90% of stimulant spending.


CONCLUSIONS
Long-acting ADHD drugs have rapidly replaced short-acting stimulant use among children with ADHD. The use of antipsychotics as a second-tier agent in treating ADHD has overtaken traditional agents such as antidepressants or alpha agonists, suggesting a need for research into the efficacy and side effects of second-generation antipsychotics among children with ADHD.
Department of Health Care Policy, Harvard Medical School, and Brigham and Women's Hospital, 180 Longwood Ave., Boston, MA 02115, USA. fullerton@hcp.med.harvard.edu
Catherine A
CA
Fullerton
Arnold M
AM
Epstein
Richard G
RG
Frank
Sharon-Lise T
SL
Normand
Christina X
CX
Fu
Thomas G
TG
McGuire
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D016527:Drug Costs / Q000639:trends; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000191:economics / Q000639:trends*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics / Q000639:trends; D001523:Mental Disorders / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D011619:Psychotropic Drugs / Q000191:economics / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
D011619:Psychotropic Drugs