Stimulant treatment and injury among children with attention deficit hyperactivity disorder: an application of the self-controlled case series study design

Raman, Sudha R.; Marshall, Stephen W.; Haynes, Kevin; Gaynes, Bradley N.; Naftel, Albert J.; Stürmer, Til

doi:10.1136/injuryprev-2012-040483

Cited by 38 publications

(44 citation statements)

References 31 publications

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“…We demonstrated a risk reduction for injuries among children with ADHD during periods of medication use; this risk reduction was statistically significant only for brain injuries. Recently, Raman et al 32 applied the SCCSD to The Health Improvement Network database and reported a risk reduction for injuries among 328 children with ADHD during periods of medication use. Our study covers a substantially larger sample from Germany.…”

Section: Discussionmentioning

confidence: 99%

Injury Prevention by Medication Among Children With Attention-Deficit/Hyperactivity Disorder

et al. 2015

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IMPORTANCE Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have an increased risk of injuries. Attention-deficit/hyperactivity disorder is often treated with medication, but the evidence regarding prevention of injuries is inconclusive. OBJECTIVE To determine via a case-only design whether the use of methylphenidate hydrochloride or atomoxetine hydrochloride reduces the risk of injuries among children and adolescents with ADHD. DESIGN, SETTING, AND PARTICIPANTS We used the German PharmacoepidemiologicalResearch Database, which includes records from about 17 million insurees (approximately 20% of the population) from 4 statutory health insurance providers in Germany to identify children aged 3 to 17 years with new diagnoses of ADHD in 2005 and 2006. We identified 37 650 children with ADHD based on inpatient and outpatient diagnostic codes (F90.0, F90.1, and F90.9) from the German modification of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Among them, we identified those with an inpatient injury diagnosis during follow-up until 2009. A total of 2128 children with any injury diagnosis at hospitalization, 821 of whom had a brain injury diagnosis, were included in the analysis. We applied the self-controlled case series design to control for time-invariant characteristics of the patients and time trends in the exposure. EXPOSURES Treatment with methylphenidate or atomoxetine based on prescription data. MAIN OUTCOMES AND MEASURES Hospitalization because of any injury or brain injury according to the injury mortality diagnosis matrix. RESULTS Incidence rate ratios for the periods with medication compared with nonmedicated periods were 0.87 (95% CI, 0.74-1.02) for hospitalization with any injuries and 0.66 (95% CI, 0.48-0.91) for brain injuries only in the full sample. These estimates remained stable in sensitivity analyses restricting the sample to a narrower age range or to patients with a single hospitalization. There was no indication that medication prescriptions are increased after hospitalizations.CONCLUSIONS AND RELEVANCE No significant risk reduction for hospitalizations with injury diagnoses was observed during periods of ADHD medication, but there was a preventive effect on the risk of brain injuries (34% risk reduction). The effects were controlled for time-invariant characteristics of the patients by the study design.

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Section: Discussionmentioning

confidence: 99%

Injury Prevention by Medication Among Children With Attention-Deficit/Hyperactivity Disorder

et al. 2015

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“…On the other hand, treating all young ADHD patients according to WHO recommendations (Figure 1), i.e., with three pills of MPH-IR per day, yearround, with a consequent reduction in grade retention and accident rates related to untreated ADHD as suggested by Barbaresi et al 13 and Raman et al 14 respectively, would lead to savings in the region of R$ 1.163 billion/ year (Table 1).…”

Section: Resultsmentioning

confidence: 99%

The Brazilian policy of withholding treatment for ADHD is probably increasing health and social costs

Maia

Stella²,

Mattos

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: To estimate the economic consequences of the current Brazilian government policy for attention-deficit/hyperactivity disorder (ADHD) treatment and how much the country would save if treatment with immediate-release methylphenidate (MPH-IR), as suggested by the World Health Organization (WHO), was offered to patients with ADHD. Method: Based on conservative previous analyses, we assumed that 257,662 patients aged 5 to 19 years are not receiving ADHD treatment in Brazil. We estimated the direct costs and savings of treating and not treating ADHD on the basis of the following data: a) spending on ADHD patients directly attributable to grade retention and emergency department visits; and b) savings due to impact of ADHD treatment on these outcomes. Results: Considering outcomes for which data on the impact of MPH-IR treatment are available, Brazil is probably wasting approximately R$ 1.841 billion/year on the direct consequences of not treating ADHD in this age range alone. On the other hand, treating ADHD in accordance with WHO recommendations would save approximately R$ 1.163 billion/year. Conclusions: By increasing investments on MPH-IR treatment for ADHD to around R$ 377 million/ year, the country would save approximately 3.1 times more than is currently spent on the consequences of not treating ADHD in patients aged 5 to 19 years.

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“…Do ADHD medications reduce school repetitions and accidents at home? Some findings are just now appearing in the literature (8).…”

mentioning

confidence: 84%

Child psychopharmacology: how much have we progressed?

Grover

Kate

2013

World Psychiatry

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Stimulant treatment and injury among children with attention deficit hyperactivity disorder: an application of the self-controlled case series study design

Cited by 38 publications

References 31 publications

Injury Prevention by Medication Among Children With Attention-Deficit/Hyperactivity Disorder

Injury Prevention by Medication Among Children With Attention-Deficit/Hyperactivity Disorder

The Brazilian policy of withholding treatment for ADHD is probably increasing health and social costs

Child psychopharmacology: how much have we progressed?

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