Objectives: The purpose of this study was to use administrative claims to examine geographic variation trends in ADD diagnostic prevalence, medication use and associated medical and pharmacy costs.
Methods: A retrospective design and descriptive analysis of continuously enrolled (medical and pharmacy benefits) commercial members aged 4 to 40 between January 1, 2008 and December 31, 2010 from MarketScan®Commercial Claims and Encounters dataset. Key metrics included percent of continuously enrolled patients with ADD diagnosis, patients with ADD medication use and associated pharmacy and medical costs per enrollee. ADD diagnosis was defined as having a medical diagnostic code (ICD9) of 3140 at any time during a given year. Medication use was defined as having at least one claim for amphetamines, attention-deficit/hyperactivity-disorder agents or stimulants.
Results: The datasets comprised of 11.8, 12 and 13 million enrollees in 2008, 2009 and 2010, respectively. Results indicate that although the diagnostic prevalence, medication use and associated medical and pharmacy costs were the highest in the South throughout the study period, Northeast region had the highest growth rate. Increasing by 34.1% from 1.9% to 2.5% for patients diagnosed and by 43.0% from 2.4% to 3.5% for patients treated with ADD medications. Growing at rate of 59.0% from $34.21 in 2008 to $54.39 in 2010, Northeast outpaced the other regions by more than 24.1% on ADD related medical and pharmacy spend per enrollee.
Conclusions: Northeast is the fastest growing region for ADD diagnosis, medication use and related spend. Further research is warranted to examine the factors underlying this trend. The findings suggest consideration of utilization management programs and cost containment strategies to ensure appropriate access, patient safety and cost-effective use of ADD medications.