• Science Update
Global use of medications that treat attention deficit/hyperactivity disorder (ADHD) nearly tripled from 1993 to 2003, and spending on the drugs rose nine-fold, according to a study co-funded by NIMH and published in the March/April 2007 issue of Health Affairs.
Using the IMS Health MIDAS, an international pharmaceutical database, Richard Scheffler, PhD of the University of California at Berkeley, and colleagues examined data from nearly 70 countries, mostly from North America, Europe and Northeast Asia. They found that among 5- to 19-year-olds, use of stimulants and non-stimulants prescribed to treat ADHD increased by 274 percent. The United States prescribes the most ADHD medications, but its share of the worldwide market declined from 87 percent in 1993 to 83 percent in 2003. ADHD medications include amphetamine (Adderall) methylphenidate (Concerta, Ritalin) and atomoxetine (Strattera).
Global expenditures on ADHD medications also increased—from less than $300 million in 1993 to $2.4 billion in 2003, adjusted for inflation. Expenditures rose fastest from 2000 to 2003 (41 percent per year) compared to an average of 18 percent per year between 1993 and 2003. The increase in spending corresponds to the advent of newer, long-acting formulations that are easier to administer but are more expensive than the short-acting medications that are administered two or three times per day. Use of short-acting formulations leveled off in 1999 and has continued to decline.
The study confirms that the United States remains the leading consumer of ADHD medications by wide margins. But other high-income countries, particularly Canada and Australia, showed higher-than-expected increases in ADHD medication use, and countries with modest use showed increases as well. In addition, more countries have begun to use the medications—from 31 in 1993 to 55 in 2003.
“Given ADHD’s prevalence and the increasing use of these medications, the disorder is poised to become the world’s leading childhood disorder treated with medication,” said Dr. Scheffler. “With this in mind, we should clearly identify the benefits and risks of these pharmacologic treatments, and promote careful prescribing and monitoring practices.”
Scheffler RM, Hinshaw SP, Modrek S, Levine P. The Global Market for ADHD Medication. Health Affairs . March/April 2007. 26(2).