Molife Cliff, Haynes Virginia S, Nyhuis Allen, Faries Douglas E, Gelwicks Steve, Kelsey Douglas K, Alatorre Carlos I
a Eli Lilly and Company - Global Patient Outcomes and Real World Evidence , Lilly Corporate Center , Indianapolis , IN , USA.
b Eli Lilly and Company - Health Outcomes , Lilly Corporate Center , Indianapolis , IN , USA.
Curr Med Res Opin. 2018 Apr;34(4):619-632. doi: 10.1080/03007995.2017.1421918. Epub 2018 Feb 5.
To compare 1-year direct healthcare costs and utilization among children and adolescents initiating non-stimulant medications atomoxetine (ATX) or extended-release guanfacine (GXR).
In this retrospective, observational cohort study, children and adolescents aged 6-17 years with attention deficit/hyperactivity disorder (ADHD) who had ≥1 prescription claim for ATX or GXR between December 31, 2009 and January 1, 2011 were identified in the MarketScan Commercial or Multi-State Medicaid claims databases. The first claim was set as the index. Patients with no claims for other ADHD medications that overlapped with the days' supply for the index therapy during the post-period were classified as initiating monotherapy. All-cause and ADHD-related utilization and costs (2011 US$) and treatment patterns (adherence and persistence) were evaluated during the 12 months following index. Propensity score adjustment accounted for differences in patient characteristics, and bootstrapping was used for comparisons.
A total of 13,239 children and adolescents with ADHD met the study criteria (4,411 ATX initiators and 8,828 GXR initiators). There were 2,699 ATX monotherapy patients. In propensity-score-adjusted analyses, mean all-cause total costs were significantly less for monotherapy ATX initiators than for GXR initiators ($7,553 vs $10,639; difference = -$3,086, p < .0001), as were mean ADHD-related total costs ($3,213 vs $4,544; difference = -$1,330, p < .0001). Monotherapy ATX initiators had significantly fewer all-cause and ADHD-related total medical visits and ∼22 days shorter persistence to index therapy (p < .0001). Results were similar for secondary analyses comparing all ATX with all GXR initiators, regardless of monotherapy or combination regimen, and comparing only monotherapy initiators.
Children and adolescents with ADHD who initiated ATX monotherapy incurred lower all-cause and ADHD-related total healthcare costs than patients who initiated GXR. This was due in part to less healthcare resource utilization and slightly shorter persistence for ATX patients. These findings may aid decision-making and inform future studies, but must be tempered due to inherent observational research limitations.
比较开始使用非兴奋剂药物托莫西汀（ATX）或缓释胍法辛（GXR）的儿童和青少年的1年直接医疗费用及医疗服务利用情况。
在这项回顾性观察性队列研究中，于MarketScan商业保险或多州医疗补助索赔数据库中识别出在2009年12月31日至2011年1月1日期间有≥1次ATX或GXR处方申请的6至17岁注意力缺陷多动障碍（ADHD）儿童和青少年。首次申请被设定为索引。在索引治疗后的观察期内，未申请与索引治疗用药天数重叠的其他ADHD药物的患者被归类为开始单一疗法治疗。在索引后的12个月内评估全因及与ADHD相关的医疗服务利用情况和费用（2011年美元）以及治疗模式（依从性和持续性）。倾向评分调整用于解释患者特征的差异，并采用自抽样法进行比较。
共有13239名ADHD儿童和青少年符合研究标准（4411名开始使用ATX的患者和8828名开始使用GXR的患者）。有2699名ATX单一疗法患者。在倾向评分调整分析中，ATX单一疗法起始者的平均全因总费用显著低于GXR起始者（7553美元对10639美元；差值 = -3086美元，p <.0001），与ADHD相关的平均总费用也是如此（3213美元对4544美元；差值 = -1330美元，p <.0001）。ATX单一疗法起始者的全因及与ADHD相关的总就诊次数显著更少，且至索引治疗的持续性短约22天（p <.0001）。对所有开始使用ATX的患者与所有开始使用GXR的患者进行比较的二次分析结果相似，无论单一疗法或联合治疗方案如何，且仅比较单一疗法起始者时结果也相似。
开始ATX单一疗法治疗的ADHD儿童和青少年的全因及与ADHD相关的总医疗费用低于开始使用GXR的患者。部分原因是ATX患者的医疗资源利用较少且持续性略短。这些发现可能有助于决策并为未来研究提供信息，但由于观察性研究固有的局限性，必须谨慎看待。
