High prescription drug use and associated costs among Medicaid-eligible children with autism spectrum disorders identified by a population-based surveillance network

Abstract

Purpose: We assessed medication use and associated costs among 8- and 15-year-old children with autism spectrum disorders (ASD) identified by the South Carolina Autism and Developmental Disabilities Monitoring (SCADDM) Network.

Methods: All Medicaid-eligible SCADDM-identified children with ASD from surveillance years 2006 and 2007 were included (n = 263). Children were classified as ASD cases when documented behaviors consistent with the DSM-IV-TR criteria for autistic disorder, Asperger disorder, or pervasive developmental disorder-not otherwise specified were present in health and education evaluation records. Medication and cost data were obtained by linking population-based and Medicaid data.

Results: All 263 SCADDM-identified children had Medicaid data available; 56% (n = 147) had a prescription of any type, 40% (n = 105) used psychotropic medication, and 20% (n = 52) used multiple psychotropic classes during the study period. Common combinations were (1) attention deficit hyperactivity disorder medications and an antihypertensive, antidepressant or antipsychotic; and (2) antidepressants and an antipsychotic. Multiple psychotropic classes were more common among older children. Both the overall distribution of the number of prescription claims and medication costs varied significantly by age.

Conclusions: Results confirm that medication use in ASD, alone or in combination, is common, costly, and may increase with age.

Figure 1

South Carolina Autism and Developmental Disabilities Monitoring (SCADDM) Network surveillance area (light grey) and subregion (dark grey).

Figure 2

The distribution for all prescriptions, nonpsychotropic prescriptions, and psychotropic prescriptions varied significantly across age groups (p<.0001, p<.0001, and p=.001 respectively). Lines shown represent smoothed density plots generated in the R package using the function density. These are similar in interpretation to histograms, but are smoothed over the range of the number of prescriptions.

Figure 3

The overall distribution of medication costs varied by age among those with any psychotropic (p=.01), and among those without psychotropics (p=.03). Lines shown represent smoothed density plots generated in the R package using the function density. These are similar in interpretation to histograms, but are smoothed over the range of costs and are scale-free.