title: Impact of atypical antipsychotic use among adolescents with attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  To compare treatment patterns, resource utilization, and costs to US third-party payers of stimulant-treated adolescent attentiondeficit/ hyperactivity disorder (ADHD) patients who switched to or augmented with atypical antipsychotics (AAPs; not FDA-indicated for ADHD) with those who switched to or augmented with nonantipsychotic medications.
  
  
  METHODS
  Retrospective cohort study conducted using a US commercial medical/pharmacy claims database.
  
  
  METHODS
  Adolescent patients with an ADHD diagnosis and ≥ 1 stimulant medication claim between January 2005 and December 2009 were identified. Patients were classified into the AAP or non-antipsychotic cohorts based on subsequent claims for AAPs or non-antipsychotic medications, respectively. Patients with psychiatric diagnoses for which AAPs are often prescribed were excluded. Patients were matched 1:1 from the AAP to the non-antipsychotic cohort using propensity score matching. Treatment patterns, resource utilization, and costs in the 12 months after AAP or non-antipsychotic initiation were compared using Cox models, Poisson regression, and Wilcoxon signed-rank tests, respectively.
  
  
  RESULTS
  After propensity score matching, a total of 849 adolescents were included in each of the matched cohorts. Patients in the AAP cohort had a significantly higher rate of medication augmentation (27.7% vs 15.5%; hazard ratio = 2.56; 95% confidence interval [CI], 1.90-3.46; P < .001) than patients in the non-antipsychotic cohort. The AAP cohort also had significantly higher incidences of inpatient admissions (0.13 vs 0.05; incidence rate ratio [IRR] = 2.45; 95% CI, 1.73-3.48; P < .001), emergency department visits (0.39 vs 0.31; IRR = 1.27; 95% CI, 1.08-1.49; P = .004), and outpatient visits (14.82 vs 13.19; IRR = 1.12; 95% CI, 1.10-1.15; P < .001), and incurred significantly higher mean annual medical ($3622 vs $3311; P = .002), drug ($4314 vs $2884; P < .001), and total healthcare ($7936 vs $6195; P < .001) costs.
  
  
  CONCLUSIONS
  Stimulant-treated adolescents with ADHD who switched to or augmented with AAPs had significantly greater drug augmentation, healthcare resource utilization, and costs compared with the non-antipsychotic cohort.
authors.affiliation: Shire Development LLC, 725 Chesterbrook Blvd, Wayne, PA 19087. E-mail: vsikirica@shire.com.
authors.forename: Vanja
authors.initials: V
authors.lastname: Sikirica
authors.forename: Steven R
authors.initials: SR
authors.lastname: Pliszka
authors.forename: Keith A
authors.initials: KA
authors.lastname: Betts
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgkins
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Samuelson
authors.forename: Jipan
authors.initials: J
authors.lastname: Xie
authors.forename: M Haim
authors.initials: MH
authors.lastname: Erder
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Dammerman
authors.forename: Brigitte
authors.initials: B
authors.lastname: Robertson
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics; D000697:Central Nervous System Stimulants / Q000191:economics / Q000627:therapeutic use; D057915:Drug Substitution / Q000191:economics / Q000706:statistics & numerical data; D004357:Drug Synergism; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants