Objectives
To compare health care resource utilization (HRU) and costs among children/adolescents with attention deficit/hyperactivity disorder (ADHD) in Quebec, Canada, who received an atypical antipsychotic (AAP) as either augmentation or alternative therapy to stimulant, before vs. after initiating the AAP.
Methods
Patients (6–17 years) with ≥2 documented ADHD diagnoses (ICD-9 codes: 314.0–314.9), who used stimulants for ≥30 days and either switched to an AAP or augmented stimulants with an AAP, were identified in Quebec’s health care database, the Régie de l’assurance maladie du Québec between 03/2007 and 02/2012. Patients with a documented diagnosis for which AAPs are indicated were excluded. All-cause and ADHD-related HRU and costs (from a public payer’s perspective in 2012 Canadian dollars) were compared between the 6-month period before (pre-index) and after (post-index) patients’ first AAP prescription claim.
Results
A total of 453 children/adolescents met the inclusion criteria (54.5% switched from stimulants to AAPs and 45.5% augmented stimulants with AAPs). The mean age was 10.4 years (SD=2.5) and 25.4% were female. The most prevalent documented mental comorbidities in the pre-index period were adjustment reaction (7.1%), anxiety disorder (5.1%), and learning disability (4.4%). Risperidone (81.7%) and quetiapine (16.3%) were the most common AAPs initiated. Compared to the pre-index period, patients incurred, on average, more all-cause outpatient visits and costs (3.2 vs. 4.6; $207 vs. $303), prescription fills and costs (13.3 vs. 22.2; $710 vs. $889), total medical costs ($644 vs. $1,096), and total health care costs ($1,354 vs. $1,985) (all p<0.05) during the post-index period. Similarly, ADHD-related total health care costs ($835 vs. $1,269; p<0.05) were higher during the post-index period; all-cause and ADHD-related total health care costs increased by 46.6% and 52.0%, respectively.
Conclusions
Children/adolescents with ADHD, who received an AAP as either augmentation or alternative therapy to stimulant, incurred higher HRU and costs after AAP initiation, mostly through ADHD-related HRU.
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© 2013 Published by Elsevier Inc.
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