Trends in psychotropic medication costs for children and adolescents, 1997-2000

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 = 83039) 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.