Advertisement

Irish Journal of Medical Science (1971 -)

, Volume 185, Issue 1, pp 171–175 | Cite as

ADHD in children: a path to free medicines

  • J. Hayden
  • M. Flood
  • F. McNicholas
Original Article

Abstract

Background

Recent media coverage has highlighted discrepancies in the entitlements of children to free ADHD medication across the country. The Department of Health has since ruled that children with ADHD under 16 are entitled to receive free medications.

Aims

This study examines the cost to the State of ADHD medication and implications for universal coverage under the long-term illness (LTI) scheme for under 16s. We estimate a potential cost for universal coverage for under 16s.

Methods

Drug reimbursement entitlements were explored for children with ADHD. Data were retrieved from the Primary Care Reimbursement Services for the Community Drug Schemes for 2011. The cumulative and percentage-spent on the LTI scheme was calculated.

Results

€107,894 (4.4 %) of the €2.4 million State spent on ADHD medicines was under the LTI scheme in 2011. We estimate a potential cost of €8.4 million for costs of ADHD medicines for the state based on current prescribing patterns.

Conclusions

There appears to be a significant underutilisation of the LTI scheme affording children free ADHD medication. Public and professional awareness campaigns are required to ensure families get the benefits to which they are entitled, and cost does not become a barrier to treatment adherence and improved outcomes. Leading from this, we propose suggestions for cost-effective prescribing to minimise potential cost implications.

Keywords

ADHD Community drugs scheme Mental illness Children Long-term illness 

Notes

Conflict of interest

None.

References

  1. 1.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, Washington, DCGoogle Scholar
  2. 2.
    Polanczyk G, de Lima M, Horta B, Biederman J, Rohde L (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948PubMedCrossRefGoogle Scholar
  3. 3.
    Lynch F, Mills C, Daly I, Fitzpatrick C (2006) Challenging times: prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents. J Adolesc 29(4):555–573PubMedCrossRefGoogle Scholar
  4. 4.
    Health Service Executive (HSE). Fourth Annual Child and Adolescent Mental Health Service Report 2011–2012. [homepage on the Internet]. 2012 cited 2014 Jan 03. Available from: http://www.hse.ie/eng/services/Publications/services/Mentalhealth/camhs20112012annualreport.pdf
  5. 5.
    Biederman J, Lopez FA, Boellner SW, Chandler MC (2002) A randomized, double-blind, placebo-controlled, parallel-group study of SLI381 (Adderall XR) in children with attention-deficit/hyperactivity disorder. Pediatrics 110(2):258–266PubMedCrossRefGoogle Scholar
  6. 6.
    Greenhill LL, Findling RL, Swanson JM (2002) A double-blind, placebo-controlled study of modified-release methylphenidate in children with attention-deficit/hyperactivity disorder. Pediatrics 109(3):e39–e39PubMedCrossRefGoogle Scholar
  7. 7.
    Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M, Swanson J et al (2006) Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry 45(11):1284–1293PubMedCrossRefGoogle Scholar
  8. 8.
    Mccracken JT, Biederman J, Greenhill LL, Swanson JM, Mcgough JJ, Spencer TJ et al (2003) Analog classroom assessment of a once-daily mixed amphetamine formulation, SLI381 (Adderall XR), in children with ADHD. J Am Acad Child Adolesc Psychiatry 42(6):673–683PubMedCrossRefGoogle Scholar
  9. 9.
    McGough JJ, Wigal SB, Abikoff H, Turnbow JM, Posner K, Moon E (2006) A randomized, double-blind, placebo-controlled, laboratory classroom assessment of methylphenidate transdermal system in children with ADHD. J Attent Disord 9(3):476–485CrossRefGoogle Scholar
  10. 10.
    Michelson D, Adler L, Spencer T, Reimherr FW, West SA, Allen AJ et al (2003) Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biol Psychiatry 53(2):112–120PubMedCrossRefGoogle Scholar
  11. 11.
    Michelson D, Allen AJ, Busner J, Casat C, Dunn D, Kratochvil C et al (2002) Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. Am J Psychiatry 159(11):1896–1901PubMedCrossRefGoogle Scholar
  12. 12.
    Wolraich ML, Greenhill LL, Pelham W, Swanson J, Wilens T, Palumbo D et al (2001) Randomized, controlled trial of OROS methylphenidate once a day in children with attention-deficit/hyperactivity disorder. Pediatrics 108(4):883–892PubMedCrossRefGoogle Scholar
  13. 13.
    National Institute for Health and Clinical Excellence (2013) NICE. Attention deificit hyperactivity disorder (CG72). [homepage on the Internet]. [updated Mar; cited 2013 Dec 20]. Available from: http://www.nice.org.uk/cg72
  14. 14.
    Hodgkins P, Arnold LE, Shaw M, Caci H, Kahle J, Woods AG et al (2011) A systematic review of global publication trends regarding long-term outcomes of ADHD. Front Psychiatry 2Google Scholar
  15. 15.
    Birnbaum HG, Kessler RC, Lowe SW, Secnik K, Greenberg PE, Leong SAet al (2005) Costs of attention deficit-hyperactivity disorder (ADHD) in the US: excess costs of persons with ADHD and their family members in 2000. Curr Med Res Opin® 21(2):195–205Google Scholar
  16. 16.
    Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS (2007) Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatrics Adolescent Med 161(9):857Google Scholar
  17. 17.
    Perwien AR, Hall J, Swensen A, Swindle R (2004) Stimulant treatment patterns and compliance in children and adults with newly treated attention-deficit/hyperactivity disorder. J Manag Care Pharm 10(2):122–129PubMedGoogle Scholar
  18. 18.
    The Fiscal Times (2013) The shocking cost of your child’s ADHD. [homepage on the Internet]. [updated Apr; cited 2013 Dec 20]. Available from: http://www.thefiscaltimes.com/Articles/2013/04/01/The-Shocking-Cost-of-Your-Childs-ADHD
  19. 19.
    Irish Examiner. HSE spent €2.5 m last year on ADHD medication, figures reveal. [homepage on the Internet]. 2013 [updated Oct 14; cited 2014 Jan 03]. Available from: http://www.irishexaminer.com/ireland/hse-spent-25m-last-year-on-adhd-medication-figures-reveal-246188.html
  20. 20.
    Long Term Illness card for ADHD. [homepage on the Internet]. Cited 2014 Jan 02. Available from: http://www.rollercoaster.ie/Discussions/tabid/119/ForumThread/14765506/Default.aspx
  21. 21.
    Long-Term Illness scheme eligibility. [homepage on the Internet]. cited 2014 Jan 02. Available from: http://www.kildarestreet.com/wrans/?id=2013-10-08a.1389
  22. 22.
    Thomas R, Mitchell GK, Batstra L (2013) Attention-deficit/hyperactivity disorder: are we helping or harming?. BMJ Br Med J 347Google Scholar
  23. 23.
    Health Service Executive (HSE). PCRS—statistical analysis of claims and payments 2011. [homepage on the Internet]. Cited 2014 Jan 03. Available from: http://www.hse.ie/eng/staff/PCRS/PCRS_Publications/pcrsclaimsandpayments2011.pdf
  24. 24.
    Gilmore A, Milne R (2001) Methylphenidate in children with hyperactivity: review and cost-utility analysis. Pharmacoepidemiol Drug Saf 10(2):85–94PubMedCrossRefGoogle Scholar
  25. 25.
    Matza LS, Paramore C, Prasad M (2005) A review of the economic burden of ADHD. Cost effectiveness and resource allocation 3(1):1–9CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2015

Authors and Affiliations

  1. 1.Royal College of Surgeons in IrelandDublinIreland
  2. 2.University College DublinDublinIreland
  3. 3.Lucena ClinicSt. John Of God Community Services DublinDublinIreland
  4. 4.Our Lady’s Children’s HospitalDublinIreland

Personalised recommendations