Comparative treatment patterns, healthcare resource utilization and costs of atomoxetine and long-acting methylphenidate among children and adolescents with attention-deficit/hyperactivity disorder in Germany.
BACKGROUND
Attention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families.


OBJECTIVE
A retrospective, propensity score-matched cohort study compared treatment patterns, healthcare resource utilization (HRU) and costs among children/adolescents with ADHD aged 6-17 years at treatment initiation (index) in Germany who received atomoxetine (ATX) or long-acting methylphenidate (LA-MPH) monotherapy.


METHODS
Patients received at least one prescription for their index medication (ATX/LA-MPH) during 2006-2010; the first prescription marked the index date. ATX- and LA-MPH-indexed cohorts were matched 1:1 (n = 737); a patient subset was identified that had not received ADHD-indicated medications in 12 months prior to index (novel initiators: ATX, n = 486; LA-MPH, n = 488). Treatment patterns were evaluated among novel initiators, and HRU and costs among the matched cohorts in the 12 months after index.


RESULTS
No significant differences in baseline characteristics were found between the novel initiator patient subsets. ATX-indexed novel initiators had significantly longer persistence to index medication [mean (standard deviation; SD) days: 222.0 (133.9) vs 203.2 (135.0), P = 0.029) but higher switching rates (8.8 vs 5.5 %, P = 0.045) than LA-MPH-indexed novel initiators. The total ATX-indexed cohort required more prescriptions [any medication; mean (SD): 20.9 (11.5) vs 15.7 (9.0), P < 0.001] and outpatient visits [mean (SD): 10.1 (6.3) vs 8.3 (5.3), P < 0.001], and incurred significantly higher total median healthcare costs (€1144 vs €541, P < 0.001) versus matched LA-MPH patients.


CONCLUSIONS
These real-world data indicate that, among children/adolescents with ADHD in Germany, ATX-indexed patients may require more prescriptions and physician visits, and incur higher total healthcare costs, than matched LA-MPH patients.
Institute of Child and Adolescent Psychiatry, Psychotherapy and Social Pediatrics, Berlin, Germany.|H:G University of Health and Sport, Technology and Arts, Berlin, Germany.
Peter
P
Greven
Shire, Wayne, PA, USA.
Vanja
V
Sikirica
IMS Health, Inc, Fairfax, VA, USA. chenyaozhu@hotmail.com.
Yaozhu J
YJ
Chen
Shire, Wayne, PA, USA.
Tammy G
TG
Curtice
IMS Health, Inc, Fairfax, VA, USA.
Charles
C
Makin
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000191:economics / Q000627:therapeutic use*; D000069445:Atomoxetine Hydrochloride / Q000191:economics / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D003692:Delayed-Action Preparations; D005260:Female; D005858:Germany; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017059:Models, Econometric; D012189:Retrospective Studies
D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride
Atomoxetine; Attention-deficit/hyperactivity disorder; Cost of illness; Methylphenidate