RWE analysis of cost of medicine for ADHD adults
DLI Market Intelligence has conducted a real-world data analysis of adults in stable treatment with attention deficit hyperactivity disorder (ADHD) medicine in order to explore the characteristics and cost of the medicine (calculated in pharmacy purchasing prices) for adults with ADHD. The annual average price per adult ADHD treatment was € 960, whereby the cheapest treatment regime had an annual average price per adult of € 40 and the most expensive, an annual average price of € 2,820.
Some of the findings from the cost analysis on ADHD medicine:
18,585 adults were identified as being on stable ADHD medication. Of these, men were over-represented by 8 percent. 54 percent of the women treated for ADHD were also treated for selected comorbidities; the corresponding rate for men was 43 percent. Older people were more frequently treated for comorbidities than younger people.
240 different treatment regimens were identified. The cost analysis covers 109 of the treatment regimens, representing 98% of adults (18,260 of the 18,585) with ADHD. The annual average price per adult ADHD treatment was € 960, whereby the cheapest treatment regime had an annual average price per adult of € 40 and the most expensive, an annual average price of € 2,820.
Looking exclusively at ADHD adults with no comorbidities (9,352 adults), their annual average price was € 850, representing 47 treatment regimes. The ADHD adults with comorbidities had a more expensive and diverse treatment regimes: the 8,908 adults were treated with 62 different ADHD treatment regimens costing an annual average price of € 1,070 per patient.
The full analysis has been delivered to the customer.
Method in brief:
Period of analysis was July 2016 – June 2017, inclusive.
Data were used from the Danish National Prescription Registry (DNPR), which is a sub-registry of The Danish National Register of Medicinal Product Statistics, DLI MI Pharmaview Dynamics, the Danish Civil Registration System (DCRS) and StatBank Denmark.
A treatment category was defined by Anatomical Therapeutic Chemical (ATC) group or by ATC group and product number, requiring at least 3 redemptions a year to be included in a category. The 10 single categories (that can be combined) were as follows: GUA (ATC group: C02AC02), DXA (ATC group: N06BA02), MDF (ATC group: N06BA07), ATX (ATC group: N06BA09), LDX (ATC group: N06BA12), and 5 categories based on product numbers within the ATC group of N06BA04 methylphenidate.
ADHD indicated medicine was defined as ATC group C02AC02 and N06BA.
Stable ADHD medicated was defined as patients that redeemed ADHD indicated medicine at least twice in the 250 days before the year of analysis. Furthermore, only patients who redeemed at least 3 prescriptions in at least 1 category of medicine during the year of analysis were included.
Included population was adults ≥ 18 years on the first day of the analysis period. The adults had to be living in Denmark in the 250 days before and during the year of analysis and on stable ADHD medication.
Comorbidity If the adult in the year of analysis had redeemed at least two prescriptions of medications selected and defined as comorbidity indicators, the adult was categorised as an ADHD adult with comorbidities. Comorbidity indicators were: SSRI (ATC N06AB), SNRI (ATC N06AX), hypnotics (ATC N05C), antipsychotics (ATC N05A)
Additional medicine. An adult was registered as having "additional medicine", if the adult on top of the stable treatment (at least 3 redemptions a year) redeemed 1 or 2 prescriptions of another treatment category. E.g. if a patient redeemed the following number of prescriptions: 7 MDF, 4 LDX, 1 GUA, 2 ATX, then the patient was included in the "MDF-LDX" treatment category (a treatment category that was not detected at all in the analysis) and the patient was furthermore registered as having "additional medicine".
A treatment regime was defined by three components: 1) the treatment category in which the adult had redeemed at least 3 prescriptions during the year of analysis, 2) comorbidity status, and 3) status on whether the adult redeemed additional ADHD medicine than the treatment categories (that is, less than 3 redemptions in 1 category per year). The above example (from additional medicine) would as such be included in the following treatment regime if the patient had no comorbidities "MDF-LDX, no comorbidity, additional medicine" (a treatment regime that was not detected in the real-world analysis).
Prices Costs were calculated based on which and how many products were actually redeemed and their price. The prices used were the pharmacy purchase prices as of April 23 – May 6, 2018. If the product belonged to a price-reference group, the A-price was used (the cheapest price). Otherwise, the price of the product was used. Strictly the ADHD indicated medicine was included in the annual average price per patient in a particular treatment regime. Any other medicine (e.g. comorbidity medicine) was not included in the price calculation. DKK was converted to € using the rate 746: 100.
Note on price-reference-group
A price-reference group is a group of substitutable products, namely products of the same substance, form, strength and size. The prices within the products of a price reference group are prioritised by the authorities, whereby the product with the cheapest price receives the reference code "A". Within products prescribed in a price reference group, it is mandatory for the pharmacist to offer the A-product to the patient. Reimbursement level is calculated from the A-price (also when the patient chooses another option within the reference group). The aim of this process is to keep the costs as low as possible for the patients as well the reimbursement authorities.
Data processor on DNPR and DCRS: Statistics Denmark, Consulting@dst.dk