Cost of ADHD treatment using methylphenidate and atomoxetine in the South African private healthcare sector.

Introduction: The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) has risen over the last two decades, with a corresponding increase in the cost of its medication. Drug utilization studies in South Africa focusing on ADHD are limited.Areas covered: The primary aim was to determine the cost of methylphenidate and atomoxetine (used for ADHD). The Intercontinental Marketing Service (IMS) database which contains data of the private healthcare sector was interrogated from 2013 to 2016 (48-month period) focussing on methylphenidate and atomoxetine. Drug consumption was expressed in number of DDDs, DDDs/1000 inhabitants/day and cost in Rands.Expert opinion: Methylphenidate-containing products constituted a considerably higher percentage of the market share when compared to atomoxetine (90.30% versus 9.70%). The DDD/1000 inhabitants/day for methylphenidate was 6.010 with an annual cost for R266 691 778 in 2013, which increased to 7.827 DDDs/1000 inhabitants/day with an annual cost of R436 041 506 in 2016. Consumption of both methylphenidate and atomoxetine increased from 2013 to 2016. There was a preference for long-acting extended-release methylphenidate tablets even though the unit costs were higher when compared to the short-acting formulations. Despite increases in unit costs, the spend in South Africa showed an upward trend for methylphenidate and atomoxetine.

Review of adult attention-deficit/hyperactivity disorder in South Africa.

INTRODUCTION: Recently, there has been a greater focus on adults with Attention-Deficit/Hyperactivity Disorder (ADHD) given that the symptoms persist in two-thirds of patients into adulthood. Areas covered: A systematic review of articles reporting on adult ADHD in SA was undertaken. From the database search, 1209 articles were identified, with 29 articles included in this analysis. Expert commentary: Fourteen of the 29 studies reviewed were exploratory, 10 were reviews/commentaries, four were developmental studies and one was a phenomenological study. More than half (58.62%) of the articles were published in local South African journals, 13.79% were published in African journals (excluding South Africa), and 27.59% of the articles were published in international journals. The impact factor for nine of the journals were not stated and the remaining 11 have impact factors ranging from 0.207 to 6.78. In 2004, only one article on adult ADHD was published in SA and by 2015, the number of publications increased to six. Adult ADHD is gaining interest in South Africa, however, there have been a limited number of studies conducted thus far. It is recommended that further studies are conducted in this new and developing field.