Currently Viewing:
The American Journal of Managed Care September 2014
Currently Reading
Impact of Atypical Antipsychotic Use Among Adolescents With Attention-Deficit/Hyperactivity Disorder
Vanja Sikirica, PharmD, MPH; Steven R. Pliszka, MD; Keith A. Betts, PhD; Paul Hodgkins, PhD, MSc; Thomas M. Samuelson, BA; Jipan Xie, MD, PhD; M. Haim Erder, PhD; Ryan S. Dammerman, MD, PhD; Brigitte
Is All "Skin in the Game" Fair Game? The Problem With "Non-Preferred" Generics
Gerry Oster, PhD, and A. Mark Fendrick, MD
Targeting High-Risk Employees May Reduce Cardiovascular Racial Disparities
James F. Burke, MD, MS; Sandeep Vijan, MD; Lynette A. Chekan, MBA; Ted M. Makowiec, MBA; Laurita Thomas, MEd; and Lewis B. Morgenstern, MD
HITECH Spurs EHR Vendor Competition and Innovation, Resulting in Increased Adoption
Seth Joseph, MBA; Max Sow, MBA; Michael F. Furukawa, PhD; Steven Posnack, MS, MHS; and Mary Ann Chaffee, MS, MA
Out-of-Plan Medication in Medicare Part D
Pamela N. Roberto, MPP, and Bruce Stuart, PhD
New Thinking on Clinical Utility: Hard Lessons for Molecular Diagnostics
John W. Peabody, MD, PhD, DTM&H, FACP; Riti Shimkhada, PhD; Kuo B. Tong, MS; and Matthew B. Zubiller, MBA
Should We Pay Doctors Less for Colonoscopy?
Shivan J. Mehta, MD, MBA; and Scott Manaker, MD, PhD
Long-term Glycemic Control After 6 Months of Basal Insulin Therapy
Harn-Shen Chen, MD, PhD; Tzu-En Wu, MD; and Chin-Sung Kuo, MD
Characteristics Driving Higher Diabetes-Related Hospitalization Charges in Pennsylvania
Zhen-qiang Ma, MD, MPH, MS, and Monica A. Fisher, PhD, DDS, MS, MPH
Quantifying Opportunities for Hospital Cost Control: Medical Device Purchasing and Patient Discharge Planning
James C. Robinson, PhD, and Timothy T. Brown, PhD
Effects of a Population-Based Diabetes Management Program in Singapore
Woan Shin Tan, BSocSc, MSocSc; Yew Yoong Ding, MBBS, FRCP, MPH; Wu Christine Xia, BS(IT); and Bee Hoon Heng, MBBS, MSc
Predicting High-Need Cases Among New Medicaid Enrollees
Lindsey Jeanne Leininger, PhD; Donna Friedsam, MPH; Kristen Voskuil, MA; and Thomas DeLeire, PhD
Cost-effectiveness Evaluation of a Home Blood Pressure Monitoring Program
Sarah J. Billups, PharmD; Lindsy R. Moore, PharmD; Kari L. Olson, BSc (Pharm), PharmD; and David J. Magid, MD, MPH

Impact of Atypical Antipsychotic Use Among Adolescents With Attention-Deficit/Hyperactivity Disorder

Vanja Sikirica, PharmD, MPH; Steven R. Pliszka, MD; Keith A. Betts, PhD; Paul Hodgkins, PhD, MSc; Thomas M. Samuelson, BA; Jipan Xie, MD, PhD; M. Haim Erder, PhD; Ryan S. Dammerman, MD, PhD; Brigitte
A retrospective study of the treatment patterns and economic outcomes associated with off-label atypical antipsychotic use in the treatment of adolescents with attention-deficit/hyperactivity disorder.
Compared with adolescent ADHD patients treated with stimulants who switched to or augmented with a non-antipsychotic medication, those who switched to or augmented with an AAP had significantly greater medical resource utilization, and higher total healthcare costs, and they were more likely to augment their treatment in the 12 months after initiating the AAP. These patients may present a greater economic burden to payers. 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.

Author Affiliations: Shire, Wayne, PA (VS, MHE); University of Texas Health Science Center at San Antonio, San Antonio, TX (SRP); Analysis Group Inc, Boston, MA (KAB, TMS, JX, EQW); and formerly at Shire, Wayne, PA (BR, PH, RSD).

Funding Source: This research was funded by Shire Development LLC, Wayne, PA.

Author Disclosures: Drs Sikirica and Erder are employees of Shire and hold stock or stock options with Shire. Drs Hodgkins, Robertson and Dammerman were employees of Shire during the time of this study. Drs Betts, Xie, and Wu, and Mr Samuelson are employees of Analysis Group, Inc, which received funding from Shire Development LLC for this study. Dr Pliszka reports consulting work for Shire and has received grants from Shire and Ortho-McNeil-Janssen Pharmaceuticals, Inc. He has also provided expert testimony for Eli Lilly and Company

Authorship Information: Concept and design (VS, SRP, KAB, PH, TMS, JX, MHE, BR, EQW); acquisition of data (VS, KAB, JX, EQW); analysis and interpretation of data (VS, SRP, KAB, PH, TMS, JX, MHE, RSD, BR, EQW,); drafting of the manuscript (VS, SRP, KAB, TMS, MHE, RSD, BR); critical revision of the manuscript for important intellectual content (VS, SRP, KAB, PH, JX, MHE, RSD, BR, EQW); statistical analysis (KAB, TMS, JX, MHE, EQW); obtaining funding (VS); administrative, technical, or logistic support (VS, PH); and supervision (PH, MHE).

Address correspondence to: Vanja Sikirica, PharmD, MPH, Shire Development LLC, 725 Chesterbrook Blvd, Wayne, PA 19087. E-mail:
1. Zuddas A, Zanni R, Usala T. Second generation antipsychotics (SGAs) for non-psychotic disorders in children and adolescents: a review of the randomized controlled studies. Eur Neuropsychopharmacol. 2011;21(8):600-620.

2. Kuehn BM. Questionable antipsychotic prescribing remains common, despite serious risks. JAMA. 2010;303(16):1582-1584.

3. Crystal S, Olfson M, Huang C, Pincus H, Gerhard T. Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges. Health Aff (Millwood). 2009;28(5):770-781.

4. Maglione M, Ruelaz Maher A, Hu J, et al. Off-label use of atypical antipsychotics: an update [Internet]. Comparative Effectiveness Review No. 43. Rockville, MD: Agency for Healthcare Research and Quality; 2011. PMID: 22132426.

5. Alexander GC, Gallagher SA, Mascola A, Moloney RM, Stafford RS. Increasing off-label use of antipsychotic medications in the United States, 1995-2008. Pharmacoepidem Drug Saf. 2011; 20(2):177-184.

6. Matone M, Localio R, Huang YS, et al. The relationship between mental health diagnosis and treatment with second-generation antipsychotics over time: a national study of U.S. Medicaid-enrolled children. Health Serv Res. 2012;47(5):1836-1860.

7. Cooper WO, Hickson GB, Fuchs C, Arbogast PG, Ray WA. New users of antipsychotic medications among children enrolled in TennCare. Arch Pediatr Adolesc Med. 2004;158(8); 753-759.

8. Pappadopulos E, Jensen PS, Schur SB, et al. “Real world” atypical antipsychotic prescribing practices in public child and adolescent inpatient settings. Schizophr Bull. 2002;28(1):111-121.

9. Cooper WO, Arbogast PG, Ding H, Hickson GB, Fuchs DC, Ray WA. Trends in prescribing of antipsychotic medications for US children. Ambul Pediatr. 2006;6(2):79-83.

10. Swensen AR, Birnbaum HG, Secnik K, Marynchenko M, Greenberg P, Claxton A. Attention-deficit/hyperactivity disorder: increased costs for patients and their families. J Am Acad Child Adolesc Psychiatry. 2003;42(12):1415-1423.

11. Hechtman L, Greenfield B. Long-term use of stimulants in children with attention deficit hyperactivity disorder: safety, efficacy, and longterm outcome. Paediatr Drugs. 2003;5(12): 787-794.

12. Findling RL, Steiner H, Weller EB. Use of antipsychotics in children and adolescents. J Clin Psychiatry. 2005;66(suppl 7):29-40.

13. Armenteros JL, Lewis JE, Davalos M. Risperidone augmentation for treatment-resistant aggression in attention-deficit/hyperactivity disorder: a placebo-controlled pilot study. J Am Acad Child Adolesc Psychiatry. 2007;46(5):558-565.

14. Correia Filho AG, Bodanese R, Silva TL, Alvares JP, Aman M, Rohde LA. Comparison of risperidone and methylphenidate for reducing ADHD symptoms in children and adolescents with moderate mental retardation. J Am Acad Child Adolesc Psychiatry. 2005;44(8):748-755.

15. Tramontina S, Zeni CP, Ketzer CR, Pheula GF, Narvaez J, Rohde LA. Aripiprazole in children and adolescents with bipolar disorder comorbid with attention-deficit/hyperactivity disorder: a pilot randomizedclinical trial. J Clin Psychiatry. 2009;70(5):756-764.

16. Zeni CP, Tramontina S, Ketzer CR, Pheula GF, Rohde LA. Methylphenidate combined with aripiprazole in children and adolescents with bipolar disorder and attention-deficit/hyperactivity disorder: a randomized crossover trial. J Child Adol Psychop. 2009;19(5):553-561.

17. Correll CU. Assessing and maximizing the safety and tolerability of antipsychotics used in the treatment of children and adolescents. J Clin Psychiatry. 2008;69(suppl 4):26-36.

18. Masi G, Liboni F. Management of schizophrenia in children and adolescents: focus on pharmacotherapy. Drugs. 2011;71(2):179-208.

19. Ben Amor L. Antipsychotics in pediatric and adolescent patients: a review of comparative safety data. J Affect Disord. 2012;138(suppl):S22-S30.

20. Sikirica V, Pliszka SR, Betts KA, et al. Comparative treatment patterns, resource utilization, and costs in stimulant-treated children with ADHD who require subsequent pharmacotherapy with atypical antipsychotics vs non-antipsychotics. J Manag Care Pharm. 2012;18(9):676-689.

21. Constantine R, Tandon R. Changing trends in pediatric antipsychotic use in Florida’s Medicaid program. Psychiatr Serv. 2008;59(10):1162-1168.

22. Bureau of Labor Statistics, US Department of Labor, 2010 Consumer Price Index.

23. Kratochvil CJ. New ADHD treatment options on the horizon. Advanced Studies in Medicine. 2002;2(25):915-918.

24. Betts KA, Sikirica V, Hodgkins P, et al. Period prevalence of concomitant psychotropic medication usage among children and adolescents with attention-deficit/hyperactivity disorder during 2009. J Child Adolesc Psychopharmacol. 2014; 24(5):268.

25. Guevara J, Lozano P, Wickizer T, Mell L, Gephart H. Utilization and cost of health care services for children with attention-deficit/hyperactivity disorder. Pediatrics. 2001;108(1):71-78.

26. Leibson CL, Katusic SK, Barbaresi WJ, Ransom J, O’Brien PC. Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder. JAMA. 2001;285(1):60-66.

27. Maayan L, Correll CU. Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol. 2011;21(6):517-535.

28. Andrade SE, Lo JC, Roblin D, et al. Antipsychotic medication use among children and risk of diabetes mellitus. Pediatrics. 2011;128(6):1135-1141.

29. Pringsheim T, Lam D, Ching H, Patten S. Metabolic and neurological complications of second-generation antipsychotic use in children: a systematic review and meta-analysis of randomized controlled trials. Drug Saf. 2011;34(8):651-668.

30. Erder MH, Signorovitch JE, Setyawan J, et al. Identifying patient subgroups who benefit most from a treatment: using administrative claims data to uncover treatment heterogeneity. J Med Econ. 2012;15(6):1078-1087.

31. Biederman J, Mick E, Faraone SV, et al. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry. 2002;159(1):36-42.

32. Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord. 2002; 5(3):143-154.

33. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45(8): 1027-1035.

34. Bussing R, Winterstein AG. Polypharmacy in attention deficit hyperactivity disorder treatment: current status, challenges and next steps. Curr Psychiatry Rep. 2012;14(5):447-449.

35. Yanofski J. The dopamine dilemma: using stimulants and antipsychotics concurrently. Psychiatry (Edgmont). 2010;7(6):18-23.

36. Penzer JB, Dudas M, Saito E, et al. Lack of effect of stimulant combination with second-generation antipsychotics on weight gain, metabolic changes, prolactin levels, and sedation in youth with clinically relevant aggression or oppositionality. J Child Adolesc Psychopharmacol. 2009;19(5):563-573.

37. Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics. 2011;127(3):462-470.
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up

Sign In

Not a member? Sign up now!