ADHD Patients More Likely to Augment Meds After Receiving Atypical Antipsychotics

Stimulant-treated adolescents with attention deficit hyperactivity disorder (ADHD) who switch to atypical antipsychotics (AAPs) show significantly greater drug augmentation, health care resource utilization, and costs compared with their counterparts who switch to nonantipsychotics, according to research published in The American Journal of Managed Care.

A multidisciplinary team of researchers studied 849 adolescents diagnosed with ADHD who had been taking at least 1 stimulant medication between January 2005 and December 2009. Patients were classified into the AAP or nonantipsychotic cohort based on subsequent insurance claims for either medication class. If a patient was eligible for both groups, then the index drug was randomly selected from the nonantipsychotic class.

Over the 1-year study period, persistence to the index drug was low in both the AAP and nonantipsychotic cohorts, with the nonantipsychotic cohort being more likely to discontinue it. Patients were more likely to augment the index drug in the AAP group compared with their nonantipsychotic counterparts, though the rate of switching was not statistically significant between the 2 groups.

In terms of health care resource utilization, a significant higher proportion of patients in the AAP group had at least 1 inpatient visit compared with the nonantipsychotic group, and the majority of such visits were related to mental health. The AAP group also had a higher emergency department (ED) visit rate, both in all cause- and mental health-related visits. Almost all patients across both groups (98.4%) had at least 1 outpatient visit, though the number of mental health-related outpatient visits was slightly higher in the AAP cohort.

The AAP group also had a higher total cost for the index drug at $1718, compared with the nonantipsychotic drug group at $632.

“Compared with adolescent ADHD patients treated with stimulants who switched to or augmented with a nonantipsychotic medication, those who switched to or augmented with an AAP had significantly greater medical resource utilization, and higher total health care costs, and they were more likely to augment their treatment in the 12 months after initiating the AAP,” the authors concluded. “Further outcomes research and/or drug utilization reviews may be necessary to fully evaluate clinical and economic outcomes in adolescents with ADHD who are receiving AAPs.”