Treatment patterns, health care resource utilization, and costs in Japanese adults with attention-deficit hyperactivity disorder treated with atomoxetine

Figures & data

Figure 1 Study schema.

Note: Depicted time intervals not to scale.

Figure 2 Inclusion criteria and sample attrition.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; ICD-10, International Statistical Classification of Diseases and Related Health Problems, 10th Revision; JMDC, Japan Medical Data Center.

Table 1 Patient demographics and index atomoxetine prescription characteristics

	All patients (N=457)
Age at index date, yearsa
Mean, SD	32.7	10.4
Median	31
Min, max	18	66
Distribution (n, %), years
18–25	137	30.0
25–30	83	18.0
>30	237	52.0
Sex (n, %)
Male	281	61.0
Female	176	39.0
Formulation (n, %)
Capsules	433	95.0
Oral solution	24	5.0
Index atomoxetine daily dose, mg
Mean, SD	42.2	26.6
Median	40
Min, max	5	150
Index atomoxetine daily dose (first claim post-index date), mg
Mean, SD	50.5	28.2
Median	40
Min, max	5	130
Index atomoxetine daily dose (second claim post-index date), mg
Mean, SD	60.6	30.5
Median	65
Min, max	5	135
Index atomoxetine daily dose (3 months post-index date), mg
Mean, SD	71.4	33.4
Median	80
Min, max	5	160

Notes: Follow-up duration calculated as number of months between the study index date and the last available medical record in the Japan Medical Data Center database.

a Index date defined as date of first observed atomoxetine prescription.

Table 2 Comorbidities present in the 6-month pre-index period

	All patients (N=457)
Mental health-related comorbidities (n, %)	329	72.0
Depression	200	43.8
Insomnia/sleep disturbances	186	40.7
Schizophrenia	112	24.5
Bipolar disorder	98	21.4
Pervasive developmental disorder	66	14.4
Autism spectrum disorder	13	19.7
Anxiety	54	11.8
Obsessive compulsive disorder	9	2.0
Drug abuse/elicit substance use disorder	6	1.3
Learning disability (unrelated to autism)	3	0.7
Behavioral disorder/conduct disorder	1	0.2
Tourette’s/Tic disorder	1	0.2
Other comorbidities (n, %)
Hyperlipidemia	70	15.3
Hypertension	30	6.6
Charlson comorbidities (n, %)
Chronic pulmonary disease	66	14.4
Diabetes without complications	53	11.6
Peptic ulcer disease	35	7.7
Cerebrovascular disease	17	3.7
Rheumatic disease	9	2.0
Congestive heart failure	7	1.5
Mild liver disease	7	1.5
Diabetes with complications	6	1.3
Peripheral vascular disease	4	0.9
Myocardial infarction	3	0.7
Renal disease	2	0.4
Moderate-to-severe liver disease	1	0.2
Charlson Comorbidity Index score
Mean, SD	0.5	0.9
Median	0
Min, max	0	6

Notes: Index date defined as date of first observed atomoxetine prescription; comorbidity prevalence estimates are inclusive of the index date.

Table 3 ADHD- and other mental health-related medication utilization

	All patients (N=457)
Stimulants (n, %)
Any methylphenidates	46	10.1
Concerta	46	10.1
Ritalin	1	0.2
Non-stimulants (n, %)
Catapressan (clonidine)	3	0.7
Any non-ADHD-specific psychotropics (n, %)	273	59.7
Atypical antipsychotic	108	23.6
Antidepressant	181	39.6
Anxiolytic	253	55.4
Non-ADHD-specific psychotropic usage in the follow-up period among comorbid depression and bipolar disorder patients in the baseline period (n, %)
Antidepressant use among patients with depression	134	67.0
Antidepressant use among patients with bipolar disorder	67	68.4
Anxiolytic use among patients with bipolar disorder	85	86.7

Abbreviation: ADHD, attention-deficit/hyperactivity disorder.

Table 4 Atomoxetine treatment patterns among adults with ADHD during follow-up period

	All patients (N=457)
Overall atomoxetine discontinuation
Discontinued (overall), n (%)	183	40.0
Discontinued temporarily, n (%)	16	3.5
Discontinued permanently, n (%)	167	36.5
Median time to discontinuation, days	49.0
Min, max	1.0	122.0
Atomoxetine persistence, n (%)
Persistent at 3 months post-index date	301	65.9
Atomoxetine adherence
MPR, mean (SD)	0.57	0.25
MPR <0.8 (non-adherent), n (%)	365	79.9
MPR ≥0.8 (adherent), n (%)	92	20.1
Switch to alternative ADHD therapy
Switched (overall), n (%)	116	25.4
New therapy class switched to, among switchers, n (%)
Methylphenidate	26	22.4
Non-stimulant (other than atomoxetine)	0	0.0
Non-ADHD-specific psychotropic	90	77.6
Median time to switch, days	63.0
Min, max	1.0	179.0
Augmentation with alternative ADHD therapy
Augmented (overall), n (%)	35	7.7
New therapy class added to index atomoxetine therapy, among augmenters, n (%)
Methylphenidate	6	1.3
Non-stimulant (other than atomoxetine)	1	0.2
Non-ADHD-specific psychotropic	30	6.6
Atypical antipsychotic	0	0.0
Antidepressant	14	3.1
Anxiolytic	26	5.7
Median time to augment, days	42.0
Min, max	0.0	121.0
Any non-ADHD-specific psychotropic in the post-index period	301	65.9

Note: Index date defined as date of first observed atomoxetine prescription.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; MPR, medication possession ratio.

Figure 3 Cardiovascular monitoring and other diagnostic utilization over all available post-index follow-up among adults with ADHD (N=457).

Abbreviation: ADHD, attention-deficit/hyperactivity disorder.

Table 5 ADHD-related health care utilization and costs among adults with ADHD during the 6-months post-index perioda

	All patients (N=457)
Hospitalizations
Had ≥1 hospitalization, n (%)	6	1.3
Number of hospitalizations per patient (among those with at least one visit)
Mean, SD	3	1.8
Median	3
Min, max	1.0	6.0
Number of days hospitalized per patient
Mean, SD	22.0	6.6
Median	22
Min, max	13.0	30.0
Costs per patient (JPY)
Mean, SD	1,022,447	753,731
Median	800,865
Min, max	335,320	2,191,920
Outpatient visits
Had ≥1 visit, n (%)	440	96.3
Number of visits per patient (among those with at least one visit)
Mean, SD	4.9	1.8
Median	6
Min, max	1.0	12.0
Number of days with a visit per patient
Mean, SD	2.2	2.4
Median	1.6
Min, max	1.0	22.5
Costs per patient (JPY)
Mean, SD	86,636	139,154
Median	46,870
Min, max	3,380	1,087,070
Pharmacy claims
Had ≥1 prescription fill, n (%)	396	86.7
Number of visits per patient (among those with at least one visit)
Mean, SD	4.9	2.0
Median	6
Min, max	1.0	15.0
Costs per patient (JPY)
Mean, SD	167,973	133,529
Median	144,870
Min, max	2,480	806,210
Total costs (inpatient, outpatient, pharmacy) per patient (JPY)
Mean, SD	246,160	227,622
Median	202,665
Min, max	2,480	2,195,350

Note:

a Index date defined as date of first observed atomoxetine prescription.

Abbreviations: ADHD, attention deficit/hyperactivity disorder; JPY, Japanese yen.