Attention-deficit/hyperactivity disorder medication consumption in 64 countries and regions from 2015 to 2019: a longitudinal study

Adrienne Y L Chan; Tian-Tian Ma; Wallis C Y Lau; Patrick Ip; David Coghill; Le Gao; Yogini H Jani; Yingfen Hsia; Li Wei; Katja Taxis; Emily Simonoff; David Taylor; Terry Y Lum; Kenneth K C Man; Ian C K Wong

doi:10.1016/j.eclinm.2022.101780

Attention-deficit/hyperactivity disorder medication consumption in 64 countries and regions from 2015 to 2019: a longitudinal study

EClinicalMedicine. 2023 Mar 20:58:101780. doi: 10.1016/j.eclinm.2022.101780. eCollection 2023 Apr.

Authors

Adrienne Y L Chan^{1

2

3

4}, Tian-Tian Ma^{2

3}, Wallis C Y Lau^{2

3

4

5}, Patrick Ip^{6

7}, David Coghill⁸, Le Gao³, Yogini H Jani^{4

5}, Yingfen Hsia^{9

10}, Li Wei^{4

5}, Katja Taxis¹, Emily Simonoff¹¹, David Taylor^{12

13}, Terry Y Lum¹⁴, Kenneth K C Man^{2

3

4

5}, Ian C K Wong^{2

3

4

5

15}

Affiliations

¹ Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy Epidemiology and Economics, University of Groningen, Groningen, the Netherlands.
² Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong SAR, China.
³ Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁴ Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom.
⁵ Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
⁶ Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁷ Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China.
⁸ Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
⁹ Centre for Neonatal and Paediatric Infection, St George's University of London, United Kingdom.
¹⁰ School of Pharmacy, Queen's University, Belfast, United Kingdom.
¹¹ Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
¹² South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, United Kingdom.
¹³ Institute of Pharmaceutical Science, King's College London, Fifth Floor, Franklin-Wilkins Building, 150 Stamford Street, London, United Kingdom.
¹⁴ Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, Hong Kong, China.
¹⁵ Aston School of Pharmacy, Aston University, Birmingham, United Kingdom.

Abstract

Background: Timely recognition and appropriate treatment of attention-deficit/hyperactivity disorder (ADHD) are essential to enhance long-term outcomes of individuals with ADHD. This study aimed to evaluate the multinational trends and patterns of ADHD medication consumption.

Methods: In this longitudinal trend study, we used pharmaceutical sales data of ADHD medication from the IQVIA-Multinational Integrated Data Analysis System between 2015 and 2019, covering 64 countries across the world. Consumption rates of ADHD medication were expressed as defined daily dose per 1000 child and adolescent inhabitants (aged 5-19) per day (DDD/TID). Linear mixed models were used to estimate the multinational, regional, and income level trend changes.

Findings: The results showed that multinational ADHD medication consumption increased by +9.72% (95% confidence interval [CI], +6.25%, +13.31%) per year, from 1.19 DDD/TID in 2015 to 1.43 DDD/TID in 2019 across the 64 countries with marked differences between geographical locations. When stratified by countries' income levels, increases in ADHD medication consumption were observed in high-income countries but not in middle-income countries. In 2019, the pooled consumption rates of ADHD medication were 6.39 DDD/TID (95% CI, 4.63, 8.84) in high-income countries, 0.37 DDD/TID (95% CI, 0.23, 0.58) in upper-middle-income countries and 0.02 DDD/TID (95% CI, 0.01, 0.05) in lower-middle-income countries.

Interpretation: Current ADHD prevalence estimates and rates of ADHD medication consumption in most middle-income countries are lower than the global epidemiological prevalence. It is therefore imperative to evaluate the potential barriers to diagnosis and treatment in these countries to minimise the risk of negative outcomes from undiagnosed and untreated ADHD.

Funding: This project was funded by a grant from the Hong Kong Research Grants Council Collaborative Research Fund (project number C7009-19G).

Keywords: Attention-deficit/hyperactivity disorder; Drug utilisation; Global health.