Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Dr, Princeton, NJ, 08540, USA.
Center for Psychiatry and Behavioral Medicine, Inc., 7351 Prairie Falcon Rd STE 160, Las Vegas, NV, 89128, USA.
BMC Psychiatry. 2022 Aug 18;22(1):555. doi: 10.1186/s12888-022-04188-4.
Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder affecting approximately 10.0% of children and 6.5% of adolescents in the United States (US). A comprehensive assessment of the current treatment landscape is warranted to highlight potential unmet needs of children and adolescents with ADHD. Therefore, this study described treatment patterns and healthcare costs among commercially insured children and adolescents with ADHD in the US.
Children and adolescents with ADHD initiating pharmacological treatment indicated for ADHD were identified from IBM MarketScan Commercial Database (2014-2018). A treatment sequence algorithm was used to examine treatment patterns, including discontinuation (≥ 180 days following the last day of supply of any ADHD treatment), switch, add-on, and drop (discontinuation of an agent in combination therapy), during the 12-month study period following the index date (i.e., first observed ADHD treatment). Total adjusted annual healthcare costs were compared between patients with and without treatment changes.
Among 49,756 children and 29,093 adolescents included, mean age was 9 and 15 years, respectively, and 31% and 38% were female. As the first treatment regimen observed, 92% of both children and adolescents initiated a stimulant and 11% initiated combination therapy. Over half of the population had a treatment change over 12 months-59% of children and 68% of adolescents. Treatment discontinuation over 12 months was common in both populations-21% of children and 36% of adolescents discontinued treatment. Healthcare costs increased with the number of treatment changes observed; children and adolescents with treatment changes (i.e., 1, 2, or ≥ 3) incurred an incremental annual cost of up to $1,443 and $2,705, respectively, compared to those without a treatment change (p < 0.001). Costs were largely driven by outpatient visits.
Over a 12-month period, treatment changes were commonly observed and were associated with excess costs, highlighting the unmet treatment needs of children and adolescents with ADHD in the US.
注意力缺陷/多动障碍（ADHD）是一种常见的神经行为障碍，影响美国约 10.0%的儿童和 6.5%的青少年。全面评估当前的治疗现状有助于突出 ADHD 儿童和青少年的潜在未满足需求。因此，本研究描述了美国商业保险覆盖的 ADHD 儿童和青少年的治疗模式和医疗保健费用。
从 IBM MarketScan 商业数据库（2014-2018 年）中确定开始接受 ADHD 药物治疗的 ADHD 儿童和青少年。使用治疗顺序算法来检查治疗模式，包括在索引日期（即首次观察到 ADHD 治疗）后的 12 个月研究期间停药（任何 ADHD 治疗的最后一天后至少 180 天）、换药、附加药物和停药（联合治疗中停用一种药物）。比较有和无治疗变化患者的总调整后年度医疗保健费用。
在纳入的 49756 名儿童和 29093 名青少年中，平均年龄分别为 9 岁和 15 岁，分别有 31%和 38%为女性。作为观察到的第一种治疗方案，92%的儿童和青少年开始使用兴奋剂，11%开始联合治疗。超过一半的人群在 12 个月内发生了治疗变化——儿童中有 59%，青少年中有 68%。在两个群体中，12 个月内停药都很常见——儿童中有 21%，青少年中有 36%。随着观察到的治疗变化数量的增加，医疗保健费用也随之增加；与未发生治疗变化的患者相比，发生 1、2 或≥3 次治疗变化的儿童和青少年的年度增量成本分别高达 1443 美元和 2705 美元（p<0.001）。成本主要由门诊就诊驱动。
在 12 个月的时间内，治疗变化很常见，与额外费用相关，突出了美国 ADHD 儿童和青少年的未满足治疗需求。
