Although treatment guidelines are largely similar, the use of pharmacological and non-pharmacological treatment for ADHD in children and adolescents varies significantly between countries. Therefore, this study assessed trends in prevalence of ADHD medication use and medication type in children and adolescents (aged 0–19 years) in Denmark, Germany, the Netherlands, the UK and the US between 2005/2006 and 2012. Prescription rates, administrative data and pharmacy dispensing data from national databases from each country were examined.*
In 2012, the number of children and adolescents who received/were eligible for ADHD medication were as follows: Germany, 30,747/1,414,623; Denmark, 18,585/1,203,817; the Netherlands, 5157/131,954; the UK, 4489/827,906; and the US 3869/105,188. From 2005/2006 to 2012, the annual prevalence of ADHD medication use increased from 1.3% to 2.2% in Germany, 0.4% to 1.5% in Denmark, 1.8% to 3.9% in the Netherlands, 0.3% to 0.5% in the UK, and from 2006 to 2012, 3.3% to 3.7% in the US. The authors noted that ADHD medication use was 6.8-fold higher in the US than in the UK.
ADHD medication use was higher in males than females in all countries (male:female ratio ranged from 2.6 to 6.6 in 2005/2006 and from 2.6 to 5.0 in 2012). The prevalence of ADHD medication use by age group was highest in the 10–14-year-old group and lowest in the 0–4-year-old group in all countries. A 6-fold increase in ADHD medication use was observed in the 15–19-year-old group between 2005/2006 and 2012.
Regarding the type of ADHD medications used, methylphenidate treatment outweighed any others in Europe between 2005 and 2012 (81.3–98.9%), whereas in the US, methylphenidate and amfetamine salt products accounted for 52.9% and 42.1%, respectively, of the US market in 2012. Atomoxetine use increased in Denmark, the Netherlands and the UK (2012 prevalence 3.7–17.8%), and in the US it dropped from 12.0% to 5.0%.
It was noted that dispensing of ADHD medication is not equivalent to actual consumption, and that not all datasets included information surrounding clinical characteristics, e.g. severity, comorbidity, co-medication, off-label use, behavioural interventions, treatment duration and adherence.
Results showed that from 2005/2006 to 2012, the prevalence of ADHD medication use grew in children and adolescents in European countries, whereas only modest changes were observed in the US. In 2012, children and adolescents in the US had ~7-fold higher use of ADHD medications than in the UK; however, youths in other European countries, especially Denmark and the Netherlands, were reducing the gap with the US.
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*Denmark, Danish Registry of Medicinal Products Statistics (RMPS); Germany, BARMER GEK (a German health insurance company); the Netherlands, IADB.nl; UK, UK Health Improvement Network (THIN); US, Children’s Health Insurance Program (CHIP)
Bachmann CJ, Wijlaars LP, Kalverdijk LJ, et al. Trends in ADHD medication use in children and adolescents in five western countries, 2005-2012. Eur Neuropsychopharmacol 2017; 27: 484-493.