Treatment patterns among adults with attention-deficit/hyperactivity disorder in the United States: a retrospective claims study

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.

Keywords:

• Attention-deficit/hyperactivity disorder
• healthcare costs
• real world
• treatment patterns
• adult

Transparency

Declaration of funding

This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. The study sponsor contributed to and approved the study design, participated in the interpretation of data, and reviewed and approved the manuscript; all authors contributed to the development of the manuscript and maintained control over the final content.

Declaration of financial/other relationships

AC received research support from Allergan, Takeda/Shire, Emalex, Akili, Ironshore, Arbor, Aevi Genomic Medicine, Neos Therapeutics, Otsuka, Pfizer, Purdue, Rhodes, Sunovion, Tris, KemPharm, Supernus, and the U.S. Food and Drug Administration; was on the advisory board of Takeda/Shire, Akili, Arbor, Cingulate, Ironshore, Neos Therapeutics, Otsuka, Pfizer, Purdue, Adlon, Rhodes, Sunovion, Tris, Supernus, and Corium; received consulting fees from Arbor, Ironshore, Neos Therapeutics, Purdue, Rhodes, Sunovion, Tris, KemPharm, Supernus, Corium, Jazz, and Tulex Pharma; received speaker fees from Takeda/Shire, Arbor, Ironshore, Neos Therapeutics, Pfizer, Tris, and Supernus; and received writing support from Takeda/Shire, Arbor, Ironshore, Neos Therapeutics, Pfizer, Purdue, Rhodes, Sunovion, and Tris. MC, PGS, JM, RB, AG and PL are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Otsuka Pharmaceutical Development & Commercialization, Inc., which funded the development and conduct of this study and manuscript. JS and JA are employees of Otsuka Pharmaceutical Development & Commercialization, Inc. 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.

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

Authors’ contributions

JS, AC, JA, MC, PGS, JM, RB, AG and PL contributed to the design of the study and interpretation of the data. MC, PGS, JM, RB, AG and PL contributed to the data analysis. All authors critically revised the draft manuscript and approved the final content.

Acknowledgements

Part of the material in this manuscript was presented at the Academy of Managed Care Pharmacy (AMCP) 2021 Virtual Meeting from April 12–16 as a poster presentation.

Medical writing assistance was provided by Christine Tam, an employee of Analysis Group, Inc.

Notes

i MarketScan is a registered trademark of IBM, Armonk, New York, USA.