Lachaine Jean, De Gourab, Sikirica Vanja, Van Stralen Judy, Hodgkins Paul, Yang Hongbo, Heroux Julie, Ben Amor Leila
Professor, Faculty of Pharmacy, University of Montreal, Montreal, Quebec.
Manager, Analysis Group Inc, Boston, Massachusetts.
Can J Psychiatry. 2014 Nov;59(11):597-608. doi: 10.1177/070674371405901106.
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.
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.
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.
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.
评估魁北克省之前接受过兴奋剂治疗的注意缺陷多动障碍（ADHD）儿童及青少年在接受非典型抗精神病药物（AAP）处方治疗时的治疗模式、医疗资源利用（HRU）及费用情况。
对2007年3月至2012年2月从魁北克省省级医疗计划数据库中提取的医疗理赔数据进行分析。纳入6至17岁正在服用兴奋剂且转而使用或加用AAP（将首次使用的AAP定义为索引AAP）且无加拿大卫生部批准使用AAP的确诊疾病记录的ADHD儿童及青少年。使用Kaplan-Meier生存分析估计索引AAP在12个月随访期内的停药、加用及换药情况。比较索引AAP开始使用前（基线期）和开始使用后6个月的HRU及费用。
共有453名ADHD儿童及青少年符合纳入标准，其中大多数为男性（74.6%），年龄在6至12岁（73.7%）。12个月的停药率、加用率及换药率分别为45.5%、68.2%和80.7%。在6个月的研究期内，患者平均全因处方配药次数更多（22.2次，而基线期为13.3次），全因药房费用（889加元，而基线期为710加元）、总医疗费用（1096加元，而基线期为644加元）及总医疗保健费用（1985加元，而基线期为1354加元）均高于6个月基线期（所有P<0.05）。同样，研究期内ADHD相关的总医疗保健费用更高（1269加元，而基线期为835加元；P<0.05）；全因及ADHD相关的总医疗保健费用分别增加了46.6%和52.0%。
魁北克省接受兴奋剂治疗的ADHD儿童及青少年使用AAP与治疗方案变更率高、医疗资源利用增加及费用增加相关。
