(B-129) Attention-Deficit/Hyperactivity Disorder Medication Utilization Among U.S. Adults Ages 18-64 Years with Commercial Insurance or Medicare: Implications for Design of Inferential Safety Studies

Background: Pharmacotherapy for adult attention-deficit / hyperactivity disorder (ADHD) is increasingly common in the United States. Information on incident use patterns and clinical characteristics of adults starting ADHD drugs could inform inferential safety studies.

Objectives: To describe baseline characteristics and longitudinal use patterns in U.S. adults starting ADHD stimulant or non-stimulant medication.

Methods: This study used the Sentinel Distributed Database of administrative claims data, January 2017 – March 2023. We identified separate, age-specific (18-25, 26-44, 45-64 years) cohorts of patients starting ≥7 days’ supply of ADHD stimulants (n=910,863) or non-stimulants (n=249,525) after 12 months enrollment (baseline period) or more of medical and drug coverage by a commercial insurance plan or Medicare Fee-For-Service. Medicare beneficiaries either had end-stage renal disease or were receiving federal disability benefits. Cumulative treatment duration included days’ supply until disenrollment or study period end; prescriptions dispensed with ≥7 days’ supply overlap were considered concomitant medication use. We calculated descriptive statistics for baseline characteristics and use patterns and qualitatively compared them among adults prescribed stimulants vs. non-stimulants, stratified by age.

Results: In each age group, those starting stimulants were less likely than those starting non-stimulants to be Medicare beneficiaries (ages 18-25 years: 2% vs. 6%; 26-44 years: 9% vs. 26%; 45-64 years: 21% vs. 43%), and less likely to have baseline medical claims for behavioral health conditions (e.g., anxiety [18-25 years: 43% vs. 59%; 26-44 years: 47% vs. 60%; 45-64 years: 49% vs. 53%] and alcohol-related disorders [18-25 years: 3% vs. 8%; 26-44 years: 4% vs. 10%; 45-64 years: 5% vs. 10%]). Amphetamine/dextroamphetamine was the most dispensed stimulant, and atomoxetine was the most dispensed non-stimulant. Over one-quarter of patients ages 26-44 years old who started a non-stimulant had prior or concomitant stimulant use. Cumulative treatment duration was longer among patients starting stimulants than among patients starting non-stimulants in all age groups (e.g., patients ages 26-44 years, median: 194 days vs. 65 days).

Conclusions: Commercial and Medicare claims data for U.S. adults starting ADHD stimulant or non-stimulant medication showed patterns of use and baseline characteristics that can inform inferential safety studies. Patients starting a non-stimulant were likely to have prior or concomitant stimulant use, and they were more likely to have baseline behavioral health diagnoses and had shorter treatment duration than patients starting a stimulant. The views expressed are the authors’ and not necessarily those of FDA.