Healthcare Costs Associated with Adverse Events in Pediatric Patients with Attention-Deficit/Hyperactivity Disorder (ADHD): A Claims-Based Study

Adverse events (AEs) are common in pediatric patients receiving attention-deficit/hyperactivity disorder (ADHD) treatment; however, real-world studies on their costs from a payer's perspective are lacking. Therefore, this study investigated the healthcare costs associated with selected AEs among pediatric patients receiving ADHD treatment in the United States. Using a retrospective cohort design, patients aged 6-17 years who received pharmacologic treatment for ADHD were identified from US claims data (October 1, 2015-September 30, 2023) and were categorized into AE and AE-free cohorts, separately for each studied AE. The eight selected AEs had statistically significant risk differences in a matching-adjusted indirect comparison of ADHD treatments and were identifiable from claims with ICD-10-CM codes. Entropy balancing was used to create cohorts with similar characteristics. Total excess healthcare costs and costs associated with AE-specific claims per patient per month (PPPM) were compared across balanced cohorts with vs. without a given AE. Overall, 393,919 patients (mean age: 12.5 years; male: 65.4%; stimulant monotherapy: 71.8%) were included, among whom 13.6% had ≥ 1 studied AE that resulted in a medical encounter during their treatment episode. The most prevalent AEs were upper abdominal pain (5.2%), vomiting (3.4%), and insomnia (3.2%). All AEs were associated with substantial AE-specific costs PPPM (asthenia: $196; somnolence: $171; insomnia: $169; vomiting: $106; dizziness: $92; upper abdominal pain: $91; irritability: $75; decreased weight: $46) and total excess healthcare costs PPPM (asthenia: $1178; somnolence: $821; vomiting: $427; insomnia: $404; dizziness: $380; upper abdominal pain: $336; irritability: $231; decreased weight: $219; all p < 0.01). AEs were common during ADHD treatment episodes in pediatric patients and were associated with significant healthcare costs. ADHD treatments with a favorable safety profile could help alleviate the economic burden of AEs.