Stimulants and Atomoxetine Use and Expenditures in Children and Adolescents in the United States

Abstract

This study examined national level prevalence and expenditure patterns of stimulants and atomoxetine in children and adolescents in the United States.  The 2003-2004 Medical Expenditure Panel Survey (MEPS) data were used to examine the utilization pattern of stimulants (amphetamine, dextroamphetamine, methylphenidate, and dexmethyl-phenidate) and atomoxetine in persons less than 20 years of age. Annual population, prescription, and expenditure estimates including 95% confidence intervals (CI) were derived after adjusting for the complex survey design of the MEPS.  Prescription expenditures in the MEPS represent the amount paid to pharmacies from all sources, including payments by insurance and patients. The expenditures were adjusted to 2004 US dollar using the Consumer Price Index.   In 2003-2004, an estimated 2.67 million (95% CI, 2.30 - 3.03 million) children and adolescents used stimulants or atomoxetine annually for an overall prevalence of 3.19% (95% CI, 2.78 - 3.60). Prevalence of stimulants alone was 2.78% (95% CI, 2.39-3.17%) with methylphenidates accounting for most of the usage. Children and adolescents using stimulants or atomoxetine were most often males (70%), whites (86%), and 10-14 years of age (52%). Nearly 90% of them reported an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis. Annual expenditures for stimulants and atomoxetine were estimated at $1.69 billion (95% CI, $1.40 - 1.98 billion), with stimulants representing 79% of the expenditure. The average prescription cost was highest ($99.48) for atomoxetine and lowest ($75.70) for methylphenidates. Atomoxetine accounted for one-fourth of the prevalence and one-fifth of the expenditures in children.  In conclusion, although stimulants accounted for most of the usage and expenditures, atomoxetine has emerged as the leading stimulant alternative in children and adolescents. High prescription costs and utilization patterns for atomoxetine are likely to influence future prescription expenditure burdens in pediatric ADHD. More research is needed on the relative cost and effectiveness of various stimulant preparations and atomoxetine.