A Comparison Of Non-ADHD-Related Health Care Costs Associated With Different Medication Treatment Modalities Among Adults With ADHD Open Access

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD), a common mental health disorder among adults, affects many aspects of a person's life including work and daily task performance, interpersonal relationships, time perception, and likelihood of injuries and driving accidents. The principal form of therapy used is stimulant and non-stimulant psychotropic medication. Theoretically, effective medication therapy would control the disorder's inattentive and impulsive components, leading to improved health status due to reduced injury rate, reduced daily stress, and better self-management of health. This improved health status could be reflected in a reduced need for non-ADHD-related healthcare resources and reduce non-ADHD-related costs. This study seeks to evaluate whether the type of ADHD medication taken is associated with non-ADHD-related costs.

This retrospective study used five years of medical and pharmacy claims data from Thomson Reuters' MarketScan^® database to compare non-ADHD-related costs among adults aged 18-64 receiving five different types of ADHD medication therapy: brand name Adderall, generic Adderall, brand name non-Adderall stimulants, generic non-Adderall stimulants, and atomoxetine (Strattera) (a non-stimulant which did not exist in a generic version during the study period). Additionally, those taking generic stimulants were compared to those taking brand name stimulants .

In the full population of adults with ADHD aged 18-64 (n=4,123) there were no significant differences in non-ADHD-related costs across the five medication groups or when comparing those taking generic versus brand name stimulants. Post hoc analyses of the subpopulation aged 18-25 (n= 1,248) indicated that those taking atomoxetine (Strattera) had significantly greater non-ADHD-related costs than those taking brand name Adderall (p<.01), generic Adderall (p<.01), or brand name non-Adderall stimulants (p<.01). There was no significant difference between those taking generic versus brand name stimulants. One possible explanation for these findings is that the impact of health issues related to injuries and accidents may be easier to detect in this age group, making it easier to identify variation in outcomes among the five different treatment groups. This study lays groundwork for future studies in adults with ADHD that seek to compare the effectiveness of different types of medication in control of ADHD symptoms, a key element of improving the ADHD patient's quality of life.

Table of Contents

TABLE OF CONTENTS

I: Introduction, Background, and Statement of Problem 1

Introduction 1
Background on ADHD 2
ADHD Definition and Types 2
Effects of ADHD in Adults 3
ADHD and Psychiatric Comorbidities 3
Treatment for Adults with ADHD 3
ADHD in Adults - Diagnosis and Onset 4
Study Objective 6
Theoretical Framework 6
Research Questions 7
Significance Statement 7
Definition of Terms 8

II: Review of the Literature 10

Introduction 10
Prevalence and Treatment of ADHD in the US 10
ADHD Distribution and Symptomatology by Sex 11
Social Consequences of ADHD 11
ADHD and Educational Attainment 12
ADHD and Employment 12
ADHD in Marriage/ Partnerships 13
ADHD and Psychiatric Comorbidities 14
Increased Health Risks for Adults with ADHD 15
ADHD and Increased Rate of Injury 15
ADHD in Adults and Non-Psychiatric Comorbidities 16
Healthcare Costs in Persons with ADHD 17

III: Method 18

Data Source 18
Database and Statistical Software 19
ADHD - Code Assignment 20
ADHD National Drug Code (NDC) List 20
Elixhauser Comorbidity Indicator Assignments 21
HEDIS Inclusion Criteria 21
Determination of Non-ADHD-Related Costs 22
Adjustment for Inflation 22
Population and Sample 23
Inclusion Criteria 23
Exclusion Criteria 23
Research Design 24
Procedures 24
Development of Analytic Database/ Population Sample 24
Study Variables 26
Outcome Variables 26
Demographic Variables 26
Comorbidities 27
Data Analysis 28

IV: Results 30

Population Statistics 30
Findings 35
Primary Research Question 35
Secondary Research Question 36
Additional Findings - Post hoc Analysis of 18- to 25-Year-Old Subpopulation 38
Comparing the Five Medication Groups in 18- to 25-Year-Olds 38
Comparing Total Non-ADHD-Related Costs in 18- to 25-Year-Olds Taking Generic versus Brand Name Stimulant ADHD Medication 41
Analysis of Average Total Injury-Related Medical Costs in 18- to 25-Year-Olds in Comparison to Average Total Injury-Related Medical Costs in the Other Age Groups 42

V: Discussion 43

Study Limitations 44
Conclusions and Recommendations 45

Appendix A - DSM-IV Criteria for Diagnosis of ADHD 46

Appendix B - List of Elixhauser Comorbidity Indicators Assigned by HCUP Software 49

References 50

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health
Keyword	atomoxetine brand name medication ADHD Adults Strattera ADHD ADD ADHD Treatment Attention Deficit/Hyperactivity Disorder ADHD Cost Outcomes ADHD Medication Adderall generic medication ADHD Stimulant Medication
Committee Chair / Thesis Advisor	Cummings, Janet, Emory University
Committee Members	Burnett, Walter M, Emory University Alperin, Melissa, Emory University Yang, Zhou, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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