Cost of ADHD treatment using methylphenidate and atomoxetine in the South African private healthcare sector

ABSTRACT

Introduction: The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) has risen over the last two decades, with a corresponding increase in the cost of its medication. Drug utilization studies in South Africa focusing on ADHD are limited.

Areas covered: The primary aim was to determine the cost of methylphenidate and atomoxetine (used for ADHD). The Intercontinental Marketing Service (IMS) database which contains data of the private healthcare sector was interrogated from 2013 to 2016 (48-month period) focussing on methylphenidate and atomoxetine. Drug consumption was expressed in number of DDDs, DDDs/1000 inhabitants/day and cost in Rands.

Expert opinion: Methylphenidate-containing products constituted a considerably higher percentage of the market share when compared to atomoxetine (90.30% versus 9.70%). The DDD/1000 inhabitants/day for methylphenidate was 6.010 with an annual cost for R266 691 778 in 2013, which increased to 7.827 DDDs/1000 inhabitants/day with an annual cost of R436 041 506 in 2016. Consumption of both methylphenidate and atomoxetine increased from 2013 to 2016. There was a preference for long-acting extended-release methylphenidate tablets even though the unit costs were higher when compared to the short-acting formulations. Despite increases in unit costs, the spend in South Africa showed an upward trend for methylphenidate and atomoxetine.

KEYWORDS:

• Attention-Deficit/Hyperactivity Disorder (ADHD)
• cost
• drug utilization
• methylphenidate
• South Africa

Article Highlights

• This is the first drug utilization study covering the cost and utilization of methylphenidate and atomoxetine in the South African private healthcare sector using data from a national database.

• The most cost-effective treatment, namely short-acting methylphenidate, is not necessarily selected as the preferred medication choice by the patient.

• Despite controversy regarding stimulant medication, i.e. methylphenidate (90.30%), this is the medication of choice for the South African population when compared to the non-stimulant option being atomoxetine (9.70%).

• Over a 4-year period, the total sales of ADHD treatment increased by 62.63% from 2013 to 2016.

• The market share for ADHD treatment is dominated by extended-release methylphenidate tablets (59.53%).

Declaration of interest

This study was funded by the Chemical Industries Education and Training Authority (CHIETA) for the first author as an employee of Cipla Medpro South Africa (PTY) LTD. Her employer has provided assistance in obtaining the grant for her PhD, however, the selection of the topic for her studies was her choice. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

APMN – Primary researcher, responsible for preparation of the article.

IT – Responsible for conceptualization of article, editing, and main supervisor for the PhD study (of which this manuscript forms part).

Ethical approval

Ethical approval to conduct the study was obtained from the university’s Research Ethics Committee (Human) (Reference number H17-HEA-PHA-001). The approval for the study was emailed on 7 February 2017. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki [44] and its later amendments or comparable ethical standards.

Additional information

Funding

This study was funded by the Chemical Industries Education and Training Authority (CHIETA).