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Treatment patterns among adults with attention-deficit/hyperactivity disorder in the United States: a retrospective claims study
Current Medical Research and Opinion ( IF 2.3 ) Pub Date : 2021-08-27 , DOI: 10.1080/03007995.2021.1968814
Jeff Schein 1 , Ann Childress 2 , Julie Adams 1 , Martin Cloutier 3 , Patrick Gagnon-Sanschagrin 3 , Jessica Maitland 3 , Rebecca Bungay 3 , Annie Guérin 3 , Patrick Lefebvre 3
Affiliation  

Abstract

Objective

To assess treatment patterns in adults with attention-deficit/hyperactivity disorder (ADHD) and associated healthcare costs in a real-world US setting.

Methods

Claims data from the IBM MarketScan Commercial Subset (Q1/2014-Q4/2018) was used to identify adults diagnosed with ADHD who newly initiated on ADHD treatment (index date). Treatment sequences were defined using an algorithm; for each sequence, the regimen comprised all ADHD-related agents observed within 30 d of the first agent during the 12-month study period. Treatment changes included discontinuation, switch, add-on, and drop. Treatment characteristics were described for the first treatment regimen observed. Total adjusted annual healthcare costs were compared between patients with no treatment change and patients with 1, 2, and ≥3 treatment changes.

Results

Among 122,881 adults with ADHD, the majority initiated a stimulant (95.1%) as their first treatment regimen observed; 9.3% of patients initiated combination therapy of ≥2 ADHD-related agents, and 34.9% of patients had psychotherapy. After an average first treatment regimen duration of 7.1 months, 50.2% of patients experienced a treatment change (22.5% discontinued, 17.5% switched, 5.3% had an add-on, and 4.6% had a treatment drop). Among those who discontinued, 44.8% did so within the first month of initiation. Mean annual healthcare costs were higher among patients with at least 1 treatment change compared to those with no treatment changes; excess costs increased with each additional treatment change.

Conclusions

Treatment changes were commonly observed and were associated with excess healthcare cost, emphasizing the unmet treatment needs of adults with ADHD in the US.



中文翻译:

美国注意力缺陷/多动障碍成人的治疗模式:一项回顾性索赔研究

摘要

客观的

评估在美国真实环境中患有注意力缺陷/多动障碍 (ADHD) 的成人的治疗模式和相关的医疗保健费用。

方法

来自 IBM MarketScan 商业子集(Q1/2014-Q4/2018)的索赔数据用于识别新近开始接受 ADHD 治疗的被诊断患有 ADHD 的成年人(索引日期)。使用算法定义治疗顺序;对于每个序列,该方案包括在 12 个月研究期间第一个药物的 30 天内观察到的所有 ADHD 相关药物。治疗变化包括停药、换药、加药和停药。描述了观察到的第一个治疗方案的治疗特征。在没有治疗变化的患者和有 1、2 和 3 次治疗变化的患者之间比较了调整后的年度医疗保健总费用。

结果

在 122,881 名患有 ADHD 的成年人中,大多数人开始使用兴奋剂 (95.1%) 作为他们观察到的第一个治疗方案;9.3% 的患者开始联合治疗≥2 种 ADHD 相关药物,34.9% 的患者接受心理治疗。在平均 7.1 个月的首次治疗方案持续时间后,50.2% 的患者经历了治疗改变(22.5% 停止治疗,17.5% 转换,5.3% 有附加治疗,4.6% 有治疗下降)。在停药的人中,44.8% 在开始的第一个月内就停药。与没有治疗变化的患者相比,至少有 1 次治疗变化的患者的年平均医疗费用更高;每次额外的治疗变化都会增加额外的成本。

结论

治疗变化经常被观察到,并且与医疗保健费用过高有关,这强调了美国成人多动症的治疗需求未得到满足。

更新日期:2021-10-29
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