title: Treatment patterns, resource use, and economic outcomes associated with atypical antipsychotic prescriptions in children and adolescents with attention-deficit hyperactivity disorder in quebec.
abstract: OBJECTIVE
  To assess treatment patterns, health care resource utilization (HRU), and costs among previously stimulant-treated children and adolescents with attention-deficit hyperactivity disorder (ADHD) receiving atypical antipsychotic (AAP) prescriptions in Quebec.
  
  
  METHODS
  Health care claims data extracted from Quebec's provincial health plan database between March 2007 and February 2012 were analyzed. Children and adolescents (6 to 17 years) with ADHD who were taking a stimulant and either switched to, or augmented with, an AAP (with the first AAP defined as the index AAP) without a documented diagnosis for which AAPs are Health Canada-approved were included. Discontinuation, augmentation, and switching of the index AAP during the 12-month, follow-up period were estimated using Kaplan-Meier survival analysis. HRU and costs for the 6 months before (baseline period) and after initiation of the index AAP were compared.
  
  
  RESULTS
  A total of 453 children and adolescents with ADHD, mostly male (74.6%) and aged 6 to 12 years (73.7%), met the inclusion criteria. The 12-month discontinuation, augmentation, and switching rates were 45.5%, 68.2%, and 80.7%, respectively. Patients had, on average, more all-cause prescription fills (22.2, compared with 13.3) and incurred more all-cause pharmacy ($889, compared with $710), total medical ($1096, compared with $644), and total health care ($1985, compared with $1354) costs during the 6-month study period than during the 6-month baseline period (all P < 0.05). Similarly, ADHD-related total health care costs were higher during the study period ($1269, compared with $835; P < 0.05); all-cause and ADHD-related total health care costs increased by 46.6% and 52.0%, respectively.
  
  
  CONCLUSIONS
  Use of an AAP among stimulant-treated children and adolescents with ADHD in Quebec was associated with high rates of therapy changes and increased HRU and costs.
authors.affiliation: Professor, Faculty of Pharmacy, University of Montreal, Montreal, Quebec.
authors.forename: Jean
authors.initials: J
authors.lastname: Lachaine
authors.affiliation: Manager, Analysis Group Inc, Boston, Massachusetts.
authors.forename: Gourab
authors.initials: G
authors.lastname: De
authors.affiliation: Senior Director, Head of Global Outcomes Research, Shire, Wayne, Pennsylvania.
authors.forename: Vanja
authors.initials: V
authors.lastname: Sikirica
authors.affiliation: Consulting Pediatrician, Centre for Pediatric Excellence, Ottawa, Ontario.
authors.forename: Judy
authors.initials: J
authors.lastname: Van Stralen
authors.affiliation: Senior Director, Global Health Economics and Outcomes Research, Shire, Wayne, Pennsylvania.
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgkins
authors.affiliation: Manager, Analysis Group Inc, Boston, Massachusetts.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Yang
authors.affiliation: Health Economist, Analysis Group Inc, Boston, Massachusetts.
authors.forename: Julie
authors.initials: J
authors.lastname: Heroux
authors.affiliation: Associate Professor, Department of Psychiatry, University of Montreal, Montreal, Quebec; Head, Department of Psychiatry, Sainte-Justine Research Centre, Montreal, Quebec.
authors.forename: Leila
authors.initials: L
authors.lastname: Ben Amor
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D002648:Child; D057915:Drug Substitution / Q000191:economics / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data*; D011792:Quebec; D014600:Utilization Review
chemical_list: D014150:Antipsychotic Agents