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Andrés Martin, MD, MPH; Douglas Leslie, PhD

Arch Pediatr Adolesc Med. 2003;157:997-1004.

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 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) and to pure inflation (44.9% of the increase, or $3.55; P for trend <.001 for all comparisons). Almost half (46.7%) of the $2.7 million 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.

From the Child Study Center (Dr Martin) and the Departments of Psychiatry and Epidemiology and Public Health (Dr Leslie), Yale University School of Medicine, New Haven, Conn; and the Northeast Program Evaluation Center, West Haven, Conn (Dr Leslie). Dr Martin has received honoraria from Janssen Pharmaceuticals and Alza Corp and has been involved in an industry-sponsored clinical trial for Bristol-Myers Squibb. Dr Leslie has served as a consultant to Pfizer and Purdue Pharmaceuticals and has received grants from Bristol-Myers Squibb and AstraZeneca.

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