This study investigates impairments and propensities for risky behaviors among adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Europe (E) and the United States (US). Data are from a web-based survey of adults who self-report having an ADHD diagnosis. Data were gathered October-December 2012 in Germany, UK, Netherlands, Sweden and the U.S. Participants were asked questions regarding social, family, educational and work-related impairments and risky personal behaviors previously shown to be common among adults with ADHD. Chi-square tests of proportions were used to test for significant differences between European and U.S. participants reported below. Three hundred European and 100 US adults reporting a diagnosis of ADHD from a health care professional completed the survey online. 60% of both European and US respondents agreed that ADHD has had a negative impact on their career success. Over one-in-four respondents reported a suspension some time during school (31% E vs. 23% US; p<0.05). Twenty-six percent of European respondents reported 3 or more traffic tickets within the past year (vs. 9% US; p<.05); 11% reported 3 or more automobile accidents during the same period (vs. 9% US). Eighteen percent of Europeans also reported having had more than three job-related accidents or injuries requiring medical attention during this period (vs. 2 % US; p<0.05). Over 40% of study participants reported illegal drug use at some time in the past (44% E vs. 48% US), with around 10% reporting citations for driving under the influence of alcohol or drugs (15% E vs. 9 % US) or serving time in prison (11% each). Concern about exposure to a sexually transmitted disease was reported by 34% European and 44% US (p<0.05) study participants. ADHD Adults from Europe and the US report various impairments and risky behaviors possibly related to their condition, some more frequent among European than US participants.

To compare socio-demographic characteristics, comorbidities, health care resource use and work productivity assessments among adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) from Europe (E) and the United States (US). Data are from the 2011 National Health and Wellness Survey (NHWS), conducted online annually by Kantar Health among samples of adults obtained from international consumer panels. Data reported in this study were gathered September-December 2011 in Germany, UK, France, Spain, Italy, and the U.S. Comparisons of ADHD and non-ADHD control populations were presented previously. Those results are extended below, by comparing to differences between European and U.S. study participants, using chi-square tests of proportions. A total of 235 European and 676 US NHWS participants reported having received a diagnosis for ADHD from a health care professional. Diagnosed ADHD respondents were more frequently male (59% E vs. 56% US) and less likely married (38% E vs. 33% US) than non-ADHD controls. ADHD respondents were more likely to report sleep difficulties (67% E vs. 44% US; p< .05), anxiety (61% E vs. 58% US), depression (59% E vs. 60% US), or headaches (57% E vs. 63% US) than non-ADHD controls. Likelihoods of an emergency room visit (34% E vs. 24% US; p<0.05), or a hospitalization (32% E vs. 12% US; p<0.05) within the past 6 months were greater among diagnosed ADHD respondents than non-ADHD controls. Diagnosed ADHD respondents were also more likely to report health-related work productivity loss (55% E vs. 34% US; p<0.05). Adults from Europe and the US reported high rates of comorbidity with various mental, emotional, or physical disorders, high rates of health resource utilization, and high rates of health-related work productivity loss, with many of these higher among European than US participants.

To evaluate daily average consumption (DACON) and average daily costs (ADC) of duloxetine for patients with various pain and mood conditions subsequent to the recent FDA approval of duloxetine in the management of chronic musculoskeletal pain. Retrospective analysis of commercially insured patients prescribed duloxetine between January 1, 2011 and September 30, 2011 using the IMS Longitudinal Prescription and Medical Claims Database. This analysis focused on patients diagnosed with only one of the following: chronic lower back pain (CLBP), osteoarthritis (OA), fibromyalgia (FM), diabetic peripheral neuropathic pain (DPNP), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Patients were assigned to study cohorts based on ICD-9 codes recorded within -180/+07 days of the date of the first duloxetine prescription filled during the study interval. DACONs were defined as weighted averages of the total number of pills dispensed by total days of supply across pill strength for all patients within each cohort. DACONs were converted to ADCs using January 2011 average wholesale prices (AWP). A second analysis based on prescriptions between January 1, 2010 and September 30, 2010 was conducted for comparative purposes. A total of 553,253 duloxetine patients were included in the analysis. DACONs were 1.27 (for CLBP, 1.26 for OA, 1.28 for FM, and 1.27 for DPNP, versus 1.44 for MDD (p<0.0001 for each of the four pain conditions) and 1.32 for GAD. The resulting ADCs for the four pain conditions varied only slightly, from $6.99 for OA to $7.13 for FM. ADC for MDD was notably higher ($8.00). The overall DACON for 2011 represented a modest decline from 2010, most notably for CLBP and FM (to 1.35 and 1.33, respectively; p<0.0001 for both). 2011 DACONs and ADCs varied little across the four chronic pain conditions for which duloxetine has been approved for use by the FDA, all of which were significantly lower than for MDD.

This study compares socio-demographic characteristics, comorbidity profiles, and functional impairments affecting adults diagnosed with attention deficit hyperactive disorder (ADHD) to their non-ADHD counterparts in Europe. Data are from the 2011 National Health and Wellness Survey (NHWS), conducted annually by Kantar Health. The NHWS has been administered annually since 2002 among samples of adults drawn from an international consumer panel recruited and maintained by Lightspeed research. Data reported in this study were gathered between September and December 2011 in Germany, UK, France, Spain, and Italy. T-tests of means and proportions were used to test for significant differences between adults with diagnosed ADHD and a non-ADHD control group from the NHWS sample. All differences reported below were significant at the p<0.05 level. A total of 235 NHWS participants reported having received a diagnosis for ADHD from a physician. Diagnosed ADHD respondents were more frequently male (59% vs. 49%) and less likely married (38% vs. 50%) than non-ADHD controls. Diagnosed ADHD respondents were more likely to report sleep difficulties (67% vs. 25%), anxiety (61% vs. 16%), depression (59% vs. 12%), or headaches (57% vs. 39%). Likelihoods of a general practitioner visit (77% vs. 65%), an emergency room visit (34% vs. 11%), or a hospitalization (32% vs. 8%) within the past 6 months were greater among diagnosed ADHD respondents than non-ADHD controls. Diagnosed ADHD respondents were also less likely employed full-time (27% vs. 39%), and more likely to report health-related work productivity loss (55% vs. 20%). Adults from 5 western European nations with self-reported diagnoses of ADHD reported higher rates of comorbidity with a variety of mental, emotional, or physical disorders, higher rates of health resource utilization, lower rates of full-time employment and higher rates of health-related work productivity impairment than adults without ADHD.

Identify and compare demographic and clinical characteristics of patients diagnosed with osteoarthritis (OA) or chronic lower back pain (CLBP) who initiated treatment on duloxetine after FDA approval of its use for management of chronic musculoskeletal pain late in 2010. Commercial patients 18-64 years of age who initiated duloxetine treatment between January 1, 2011 and July 30, 2011 were identified in the IMS Longitudinal Prescription and Medical Claims Database. The index event was defined as the first duloxetine prescription fill with no duloxetine pill-coverage for 90 days prior. Patients were assigned to disease-category cohorts on the basis of ICD-9 codes on medical claims dated within -180/+7 days of the index event. χ2-tests were used to compare differences across study cohorts. Additional cohorts based on other FDA approved duloxetine indications and for the same time period a year prior to the primary study period were constructed for comparison. A total of 422,911 duloxetine initiators with >1 of duloxetine's six approved indications were identified in the IMS database, of which 80,637 had either CLBP (42,280) or OA (38,357) as the only diagnosed condition from among the six. OA patients were older than CLBP patients (60.6 vs. 52.1 years; p<0.001). An almost equal proportion of OA and CLBP patients (47%) were treated by primary care physicians. CLBP patients were more likely prescribed an anticonvulsant (52.7% vs 37.3%; p<0.001) or an opioid (93.5% vs. 84.1%; p<.001) than were OA patients. OA patients were more likely to have been previously diagnosed with a non-CLBP related musculoskeletal pain condition. OA patients were more likely to initiate duloxetine treatment at sub-therapeutic (<40 mg/day) dosing levels than CLBP patients (32.1% vs. 26.8%; p<0.001). Results for 2011 were little changed from 2010 results. Overall, patient profiles among duloxetine initiators with CLBP displayed modest differentiation relative to patients with OA in 2011.

To develop and apply a longitudinal model adjusting for pre-treatment covariates to examine trajectory patterns of health care costs in patients with major depressive disorder (MDD) treated with duloxetine. Retrospective health care cost data from Thomson Reuters MarketScan® Database for 10,987 MDD patients, aged 18-64 initiating duloxetine in 2007 at low, standard, or high doses (<60, 60, or >60 mg/day) were used to build a longitudinal model for the examination of trajectory patterns of patient-level health care costs. The model was adjusted for baseline demographics, Charlson comorbidity index (CCI), body system index (BSI), and prior medication index (PMI). Rates of change (slopes) were estimated from the fitted model and differences in the cost trajectory patterns among dosing cohorts were tested using F-test. Bootstrapping was used to provide a sensitivity analysis. A repeated measures linear mixed model with dose, month, and dosemonth as fixed effects and patient, patientdose as a random effects, adjusting for demographics, CCI, BSI, and PMI, was developed. Main effects and covariates were all significant (all p<.05). The model revealed that total health care costs increased sharply in the months leading up to, and decreased in the months following, initiation of duloxetine treatment for each dosing cohort and the overall cohort (all p<.05). Compared to patients given low- or standard-dose therapy, patients who received high-dose duloxetine had higher health care expenses both prior to and following initiation of duloxetine therapy (p<.05). Bootstrapping confirmed the above test results. Longitudinal models provide great opportunities to assess changes in cost trajectory patterns around the time of changes in medical treatment compared to the current standard mean methods. In this analysis, health care costs increased prior to the initiation of duloxetine therapy, perhaps signaling a clinical deterioration that led to a change in treatment strategy. Health care costs then decreased following initiation of duloxetine treatment.

The purpose of this study was to compare adherence and persistence for patients treated with duloxetine across several diagnoses categories: major depressive disorder (MDD), fibromyalgia (FM), osteoarthritis (OA), and chronic lower back pain (CLBP). Patients age 18-64 initiating duloxetine treatment during 2008 were identified in the Thomson Reuters MarketScan® Database. The index event was defined as the first duloxetine prescription filled during the study period with no duloxetine coverage during the previous 90 days. Patients were assigned to disease-category cohorts on the basis of ICD-9 codes recorded on medical claims dated within +1/- 3 month of the initial duloxetine prescription. Adherence was measured over both 365- and 90-day post duloxetine initiation periods as the percent of patients with a medication possession ratio ≥ 0.8. Persistence was measured over a 365-day post-initiation period as the percent of patients with length of therapy ≥ 180 days. χ2-tests were used to compare differences in adherence and persistence across patient cohort. A total of 18,406 patients with one of the 4 identified diagnosis categories were identified as initiating duloxetine in 2008: MDD (8,334), FM (3,630), OA (1,458) or CLBP (4,984). Adherence was directionally greater among patients with MDD (37.3%) versus FM (35.3%) or OA (35.7%), and statistically significantly greater than CLBP (29.9%; p<0.005). Comparisons of 90-day adherences were similar, with MDD (58.8%) directionally higher than FM (54.1%) or OA (57.8%), and statistically significantly greater than CLBP (50.0%; p<0.005). Comparisons of persistence were similar to adherence. For example, persistence was 47.5% for MDD versus 38.7% for CLBP (p<0.005). Duloxetine adherence and persistence were similar among patients with MDD, FM, and OA, and significantly less among those with CLBP. These relationships were consistent across variations in technical assumptions employed in calculating the study measures.

This secondary analysis of REFLECTIONS, a prospective observational study of patients initiating on medications for fibromyalgia, compared patient, clinical, and treatment characteristics between United States (US) and Puerto Rico (PR). Baseline data were collected from July 2008 through May 2010 via physician surveys, office visit forms, and telephone interviews in 58 care settings in the US and PR. Study patients included 1539 (90.5%) treated in the US and 161 (9.5%) in PR. Patient characteristics differed for mean age in years (53.8 PR vs. 50.0 US, p<.001), body mass index (30.4 PR vs. 31.4 US, p=.049) and race/ethnicity (98.1% Hispanic PR vs. 91.4% Caucasian US). Patients in PR versus the US were more likely to have a lower category of economic status and less likely to be privately insured. PR patients had more total concomitant diseases including back pain and depression (all p<.001). Times to first symptom, diagnosis, and prescription were shorter in PR than US (all p<.01). Patients in PR also reported more severe pain, pain interference, and greater disease impact via the Brief Pain Inventory and the Fibromyalgia Impact Questionnaire (all p<0.001). Treatment patterns also differed with US patients more likely to be prescribed opioids (5.6% PR vs. 26.2% US) and exercise (81.4% PR vs. 90.3% US), but less likely to be prescribed NSAIDS (55.9% PR vs. 23.6% US), (all p<.001). Despite the strong evidence for efficacy, cognitive behavioral therapy was prescribed infrequently (3.1% PR vs. 4.7% US, p=0.36). To the best of our knowledge, this is the first study to describe patient and treatment characteristics for patients with fibromyalgia in PR. Patient, clinical, and treatment characteristics of REFLECTIONS patients in PR differed in several respects from the US cohort. It is unknown whether these findings are generalizable to all fibromyalgia patients in the US and PR.

OBJECTIVE: To determine if the type of antidepressant drug is related to adherence to National Committee for Duality Assurance (NCQA) Antidepressant Medication Management (AMM) quality measures and to assess the 6-month health care costs among newly diagnosed depressed patients.METHODS: The MarketScan Commercial Claims and Encounter database for medical and pharmacy claims from January 2001 to September 2004 was used to assess adherence to the 3 AMM quality-of-care measures. AMM measures include (a) acute phase, the percentage of eligible members who remained on antidepressant medication continuously for 3 months after the initial diagnosis as determined by at least 84 days supply of antidepressant drugs during the first 114 days following receipt of the index antidepressant; (b) continuation phase, the percentage of eligible members who remained on antidepressant medication continuously for the 6 months after the initial diagnosis as determined by at least 180 days supply of antidepressants during the first 214 days following receipt of the index antidepressant; and (c) practitioner contacts, the percentage of members who received at least 3 follow-up office visits or telephone contacts with health care providers, including at least 1 contact with a practitioner licensed to prescribe (may not necessarily be the prescriber of the antidepressant). A fourth measure, overall adherence, was added, if all 3 AMM measures were met. Multivariate regression models determined demographic, clinical (such as receipt of mental health specialty care, the Chartson Comorbidity Index score, and co-occurring bipolar or schizophrenia), and therapy-related factors associated with outcomes of adherence and costs (paid amounts for insurance-reimbursable health care services for inpatient admissions, emergency department services, outpatient services, and outpatient prescription drugs). Health care expenditures (both total and mental-health-specific costs) were measured for each patient for 6 months following the date of service for the index antidepressant.RESULTS: A total of 60,386 adult patients (10.7%) of 562,898 patients with a depression diagnosis met NCGA inclusion criteria in the AMM Technical Specifications (e.g., aged 18 years or older, newly diagnosed with depression and initiating antidepressant therapy, 365 days of continuous enrollment; patents were excluded if there were missing data on dose or quantity of index drug in pharmacy claims or initiated therapy on 2 or more antidepressants as the index medication, exclusion criteria not in the AMM Technical Specifications). Only 19% of patients achieved overall adherence. Rates for the 3 AMM measures were 39% for practitioner contacts, 65% for acute phase, and 44% for continuation phase. Receipt of mental health specialty care was the only factor that was positively associated with greater adherence on all 4 measures (overall measure: odds ratio [OR] = 3.895, 95% confidence interval 1% 3.72-4.07; acute OR = 1.38, 95% CI, 1.33-1.43; continuation OR = 1.46, 95% CI, 1.41-1.51; contacts OR = 5.83, 95% CI, 5.62-6.06). Most patients were initiated on selective serotonin reuptake inhibitors (SSRIs, 69.5%), followed by venlafaxine (21.4%), tricyclic antidepressants (TCAs, 21.4%), bupropion (11.0%), and other antidepressants (e.g., mirtazapine, nefazadone, trazadone; 7.2%). Before adjustment for confounding factors, patients initiated on venlafaxine, TCAs, or other antidepressants had higher rates of adherence on the overall performance measure versus initiators on SSRIs, but the absolute differences were relatively small: 21.4% for venlafaxine and TCAs and 23.1% for other antidepressants versus 18.5% for SSRIs (P < 0.001). Patients initiated on venlafaxine, TCAs, or other antidepressants were also more likely to receive care from a mental health specialist, 16.8%, 15.0%, and 54.8%, respectively, compared with SSRIs (13.0%, all P < 0.001). Regression analysis showed that only venlafaxine had a higher OR (1.13; 95% CI, 1.05-1.22) compared with SSRIs for adherence measure. Initiating dose level was in the target range for 70.0% of all patients (24.9% were below target dose and 5.2% above target dose), and adherent patients on all 3 AMM measures were less likely than nonadherent patients (70.4% vs. 68.4%, P < 0.001) to be initiated in the target dose range. After multivariate adjustment, the initiating dose (target vs. high) was a significant factor in explaining adherence to the overall measure (OR = 1.26; 95% CI, 1.16-1.37). Adherent patients had 6-month median unadjusted total health care expenses that were nearly 2 times higher compared with nonadherent patients ($5,169 vs. $2,734) and mental health expenditures that were nearly 3 times higher ($1,922 vs. $677). After adjustment, adherent patients compared with nonadherent patients incurred an additional $644 in mental health expenditures and S806 in overall health care expenditures in the 6 months following initiation of antidepressant therapy.CONCLUSIONS: Only 19% of depressed patients initiated on antidepressants met all 3 criteria set forth in the NCQA Health Plan Employer Data and Information Set (HEDIS) AMM quality-of-care performance measures. Receipt of mental health specialty care was the single factor most strongly associated with quality treatment by these measures. Type and dosage level of initial antidepressant was associated with adherence to the NCQA HEDIS AMM measures, but the absolute difference in rates of adherence were relatively small among types of antidepressants. Costs were higher for guideline-adherent individuals in the 6 months following treatment initiation. These analyses were limited to administrative claims that lack indicators of depression disease severity.