Atypical Antipsychotics in Adolescents with ADHD

San Francisco – A pharmacoeconomic analysis presented in a poster session during the AMCP meeting concluded that atypical antipsychotics (AAPs) used as a switch from, or augmentation of, stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) in adolescents was associated with a significantly greater need for drug augmentation, healthcare utilization, and costs. The poster was titled Atypical Antipsychotics versus Non-Antipsychotics: Comparative Treatment Patterns, Resource Utilization, and Costs in Stimulant-Treated Adolescents with ADHD Who Require Subsequent Pharmacotherapy.

Researchers conducted an analysis of a large US commercial medical and pharmacy claims database, including patients 13 to 17 years of age with an ADHD diagnosis and at least 1 stimulant medication claim between January 2005, and December 2009. Each matched cohort of AAP and non-antipsychotic medication users consisted of 849 patients. The analysis was restricted to the 12 months after treatment initiation, and focused on treatment patterns, resource utilization, and healthcare costs with the use of AAPs versus non-antipsychotic medications for ADHD management.

Although AAPs are not indicated for the treatment of ADHD, the authors explained, AAPs are sometimes prescribed for these patients, especially when stimulants alone are inadequate for symptom control. They noted a recent analysis reporting that 8.3% of all ADHD patients treated with medication were prescribed an AAP after a stimulant, and that 69% of ADHD patients with an AAP prescription did not have a psychiatric diagnosis for which these agents were indicated.

The baseline characteristics of the AAP and non-antipsychotic drug use cohorts were well matched. During the 12 months after treatment initiation, the analysis found that compared with the non-antipsychotic drug use cohort, those using AAPs had significantly lower rates of discontinuation, similar rates of switching to a new drug, significantly higher rates of augmentation with a new drug, and significantly higher rates of adherence to the index drug.

The AAP cohort was significantly more likely to require hospitalization, emergency department (ED) visits, or outpatient visits. In addition, the AAP cohort incurred significantly higher total, medical, and prescription drug costs. Costs for inpatient and ED visits were also significantly higher in the AAP cohort compared with the non-antipsychotic drug use cohort. Outpatient costs were similar between the 2 treatment groups.

The use of AAPs was also associated with significantly higher mental health-related inpatient, ED, outpatient, and prescription drug costs.

The authors noted that this analysis was the first, to their knowledge, that focused on the economic consequences of treating ADHD with AAPs in the adolescent population, using real-world data. They added that the greater resource utilization and healthcare costs associated with AAPs versus non-antipsychotic medications suggests a substantial incremental cost burden to payers.

The authors cautioned that differences in baseline variables may have been undetected in the analysis, and the findings may only be generalized to a US commercial ADHD population. In addition, they stressed that longer term data beyond 12 months are needed to determine the long-term economic impact of ADHD management with AAP therapy.

This study was supported by Shire Development.