Trends in psychotropic medication costs for children and adolescents, 1997-2000

Arch Pediatr Adolesc Med. 2003 Oct;157(10):997-1004. doi: 10.1001/archpedi.157.10.997.

Abstract

Objective: To examine trends in psychotropic medication utilization and costs for children and adolescents between January 1, 1997, and December 31, 2000.

Methods: Pharmacy claims were analyzed for mental health users 17 years and younger (N = 83 039) from a national database covering 1.74 million privately insured youths. Utilization rates and costs for dispensed medications were compared across psychotropic drug categories and individual agents over time.

Results: Overall use of psychotropic drugs increased from 59.5% of mental health outpatients in 1997 (a 1-year prevalence of 28.7 per 1000) to 62.3% in 2000 (33.7 per 1000), a 4.7% increase. The largest changes in utilization were seen for atypical antipsychotics (138.4%), atypical antidepressants (42.8%), and selective serotonin reuptake inhibitors (18.8%). The average prescription price increased by 17.6% (7.90 US dollars per prescription), a change in turn attributed to a shift toward costlier medications within the same category (55.1% of the increase, or 4.35 US dollars) and to pure inflation (44.9% of the increase, or 3.55 US dollars; P for trend <.001 for all comparisons). Almost half (46.7%) of the 2.7 million US dollars gross sales differential was accounted for by only 3 of the 39 drugs identified (amphetamine compound, risperidone, and sertraline), and 75% was accounted for by 7 drugs (the previous 3 and bupropion, paroxetine, venlafaxine, and citalopram).

Conclusions: Psychotropic drug expenditure increases during the late 1990s resulted from more youths being prescribed drugs, a preference for newer and costlier medications, and the net effects of inflation. The impact of managed care and pharmaceutical marketing effects on these trends warrants further study.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Child Welfare
  • Child, Preschool
  • Costs and Cost Analysis / economics
  • Costs and Cost Analysis / trends
  • Cross-Sectional Studies
  • Drug Utilization / economics
  • Drug Utilization / trends
  • Humans
  • Mental Health Services / economics
  • Mental Health Services / statistics & numerical data
  • Mental Health Services / trends
  • Prescription Fees / trends*
  • Prevalence
  • Psychotropic Drugs / classification
  • Psychotropic Drugs / economics*
  • United States / epidemiology

Substances

  • Psychotropic Drugs