Stakeholder Insight: ADHD - Prescriber Attention Still Held by Short Acting Stimulant Drugs
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the CNS pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the ADHD market - page 5
- Key metrics - page 6
- CHAPTER 2 INTRODUCTION AND SCOPE - page 16
- Coverage of the Stakeholder Insight Survey - page 16
- Epidemiology and diagnosis of ADHD - page 16
- Referral patterns - page 16
- Treatment of ADHD - page 17
- Drug profiles - page 17
- Coverage of the Stakeholder Insight Survey - page 16
- CHAPTER 3 COUNTRY TREATMENT TREES - page 18
- US - page 18
- Japan - page 22
- France - page 26
- Germany - page 29
- Italy - page 32
- Spain - page 35
- UK - page 38
- CHAPTER 4 EPIDEMIOLOGY & PATIENT SEGMENTATION - page 41
- Key findings - page 41
- Disease definition and classification - page 42
- Etiology of ADHD - page 42
- Structural abnormalities - page 42
- Genetic predisposition - page 42
- Neurotransmitter dysfunction - page 43
- Diagnostic criteria of ADHD - page 43
- Etiology of ADHD - page 42
- Epidemiology of ADHD - page 45
- Prevalence of ADHD - page 45
- Age of onset of ADHD - page 48
- Progression to adult ADHD - page 49
- Key patient segments - page 51
- Gender - page 51
- Comorbidities - page 55
- Mood disorders and depression - page 56
- Anxiety disorders - page 58
- Tic disorder and Tourette's syndrome - page 60
- Autistic and Asperger's disorder - page 62
- Oppositional defiant disorder and conduct disorder - page 62
- Substance abuse - page 64
- Learning disabilities - page 65
- CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS - page 68
- Key findings - page 68
- Diagnostic guidelines - page 69
- Summary of DSM-IV criteria for the diagnosis of ADHD - page 69
- Summary of ICD-10 criteria for the diagnosis of HKD - page 70
- ADHD diagnostic algorithm - page 70
- Diagnostic complications - page 73
- Hyperkinesis versus attention deficit hyperactivity disorder - page 73
- Gender - page 74
- Age - page 74
- Duration of symptoms - page 75
- Diagnostic complications - page 73
- Diagnostic tools - page 75
- ADHD Rating Scale - page 75
- Copeland symptom checklist - page 75
- Barkley's Current Symptoms Scale-Self Report Form (home and school) - page 75
- Brown ADD Scale (diagnostic form) - page 76
- Parent-completed Child Behavior Checklist - page 76
- Teacher Report Form (TRF) of Child Behavior Checklist - page 76
- ADD-H: Comprehensive Teacher Rating Scale (ACTeRS) - page 77
- Frequency of diagnostic tool usage - page 77
- Diagnosis rates - page 79
- Time to diagnosis - page 82
- Diagnostic unmet needs - page 84
- Referral patterns - page 87
- Direct consultations - page 87
- Referral patterns of interviewed physicians - page 89
- Types of medical professional referred to - page 91
- Treatment planning - page 94
- Treatment guidelines - page 94
- AAP guidelines - page 95
- The Texas Children's Medication Algorithm - page 97
- UK NICE guidelines - page 98
- Pharmacological treatments - page 99
- Stimulants - page 99
- Amphetamines - page 102
- Adderall and Adderall XR - page 102
- Dextroamphetamines - page 103
- Dexedrine and Dexedrine SR/Spansule - page 103
- Dextrostat - page 103
- Methylphenidate - page 104
- Ritalin - page 104
- Focalin - page 105
- Metadate - page 106
- Methylin - page 107
- Concerta - page 107
- Cylert - page 108
- Non-stimulants - page 109
- Strattera - page 109
- Drugs prescribed off label - page 110
- Antidepressants - page 110
- α2-agonists - page 112
- Antipsychotics - page 112
- Non-pharmacological therapy - page 113
- Economic consequences - page 114
- CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS - page 116
- Key findings - page 116
- Introduction - page 117
- Prescribing trends - page 117
- Pharmacological versus non-pharmacological therapy - page 117
- First-line treatment strategies - page 120
- Drug classes prescribed in first-line therapy - page 122
- Drugs prescribed in first-line therapy - page 124
- Children - page 124
- Adolescents - page 126
- Immediate- versus modified-release drugs - page 127
- Country-specific first-line therapy - page 129
- US - page 130
- Japan - page 131
- Progression to second-line therapy - page 131
- Second-line treatment strategies - page 134
- Drug classes prescribed in second-line therapy - page 136
- Second-line add-on strategies - page 137
- Immediate- versus modified-release drugs in add-on therapy - page 139
- Drugs used in second-line add-on therapy - page 140
- Second-line switch strategies - page 142
- Immediate- versus modified-release drugs in switch therapy - page 144
- Drugs used in second-line switch therapy - page 145
- US - page 147
- Japan - page 148
- Europe - page 148
- Factors influencing physician decision making - page 149
- Drug attributes - page 149
- Parent and patient influence - page 151
- Product profiles - page 152
- CHAPTER 7 IMPROVING TREATMENT OUTCOMES - page 156
- Key findings - page 156
- Unmet needs of ADHD - page 157
- Longer-acting therapies - page 157
- How to improve the perceived efficacy and uptake of longer-acting therapies - page 158
- Zinc - page 159
- Immediate- and modified-release combinations - page 161
- Pharmacokinetics - page 163
- Novel formulations - page 164
- INSULIN PENS - page 167
- BAND-AID - page 168
- MULTIVITAMINS - page 169
- METADATE CD - page 169
- Advocacy initiatives - page 169
- National ADHD Awareness Day - page 169
- New product development - page 171
- Methypatch (transdermal methylphenidate) - page 172
- Focalin LA (dexmethylphenidate) - page 173
- SPD-503 - page 175
- Provigil (modafinil) - page 176
- ABT-089 - page 178
- NS-2359 - page 178
- Recently discontinued drugs - page 179
- SPD473 - page 179
- CHAPTER 8 OPINION LEADER TRANSCRIPTS - page 180
- KOL 1 - page 180
- KOL 2 - page 189
- APPENDIX A - page 201
- Bibliography - page 201
- Websites - page 207
- APPENDIX B - page 209
- Physician sample breakdown - page 209
- Physician research methodology - page 213
- Contributing experts - page 213
- APPENDIX C - page 214
- Physician questionnaire - page 214
- Report methodology - page 235
- Date of research completion - page 235
- About Datamonitor - page 235
- About Datamonitor Healthcare - page 235
- Datamonitor Healthcare's research and analysis methodologies - page 236
- Datamonitor Healthcare's therapy area capabilities - page 236
- About the CNS analysis team - page 237
- Datamonitor Healthcare's Consulting expertise - page 238
- Datamonitor's Therapeutic Consulting expertise - page 239
- Key therapy team members - page 239
- Lynda Lynch, Director CNS - page 239
- David Abramson, Therapeutic Lead Consultant - page 240
- Disclaimer - page 241
- List of Tables
- Table 1: Patients diagnosed with ADHD across the seven major markets (2004 to 2010) (000s). - page 7
- Table 2: Symptoms for ADHD/HKD in the DSM-IV and ICD-10 - page 44
- Table 3: Definition of ADHD in the DSM-IV - page 45
- Table 4: Prevalence of ADHD across the seven major markets - page 46
- Table 5: Prevalence of ADHD - page 47
- Table 6: Proportion of males vs. females across the seven major markets - page 52
- Table 7: Prevalence of comorbid disorders in ADHD (%) - page 56
- Table 8: DSM-IV categorization of ADHD. - page 69
- Table 9: ICD-10 categorization of hyperkinetic disorders - page 70
- Table 10: Frequency of diagnostic tool usage (%) - page 78
- Table 11: Diagnostic tools used by PCPs vs. Psychiatrists (%) - page 78
- Table 12: Prevalence breakdown of ADHD across the seven major markets (2004) - page 82
- Table 13: Professionals who make diagnoses of ADHD - page 87
- Table 14: Proportion of patients referred to another physician type - page 90
- Table 15: Proportion of patients referred to other medical professionals by PCPs - page 91
- Table 16: Proportion of patients referred to other medical professionals by psychiatrists - page 92
- Table 17: Stimulants approved for the treatment of ADHD - page 99
- Table 18: Non-stimulants approved for the treatment of ADHD - page 109
- Table 19: Drugs used off label for the treatment of ADHD - page 111
- Table 20: Therapy types used in the treatment of ADHD - page 117
- Table 21: Drugs used in first-line monotherapy in children across the seven major markets (%) - page 125
- Table 22: Drugs used in first-line monotherapy in adolescents across the seven major markets (%) - page 126
- Table 23: Immediate- vs. modified-release drugs prescribed in children at first-line across the seven major markets - page 127
- Table 24: Immediate- vs. modified-release drugs prescribed in adolescents at first-line across the seven major markets - page 128
- Table 25: Top three drugs prescribed for the treatment of ADHD in children across the seven major markets - page 129
- Table 26: Top three drugs prescribed for the treatment of ADHD in adolescents across the seven major markets - page 129
- Table 27: Add-on strategies in the second-line treatment of children with ADHD - page 137
- Table 28: Add-on strategies in the second-line treatment of adolescents with ADHD - page 138
- Table 29: Immediate- vs. modified-release drugs prescribed to children and adolescents in second-line add-on therapy across the seven major markets - page 139
- Table 30: Second-line add-on therapy in children and adolescents - page 140
- Table 31: Top three drugs prescribed for the treatment of ADHD in children and adolescents across the seven major markets - page 141
- Table 32: Switching strategies in the second-line treatment of children with ADHD - page 142
- Table 33: Switching strategies in the second-line treatment of adolescents with ADHD - page 143
- Table 34: Immediate- vs. modified-release drugs prescribed to children at second-line switch therapy across the seven major markets - page 144
- Table 35: Immediate- vs. modified-release drugs prescribed to adolescents at second-line switch therapy across the seven major markets - page 144
- Table 36: Second-line switch therapy children - page 145
- Table 37: Second-line switch therapy adolescents - page 146
- Table 38: Top three drugs prescribed to children in second switch therapy across the seven major markets - page 147
- Table 39: Top three drugs prescribed to adolescents in second switch therapy across the seven major markets - page 147
- Table 40: Top three drugs characterized by physicians across the seven major markets - page 155
- Table 41: ADHD pipeline products, 2004 - page 171
- Table 42: Price of Provigil and marketed once-daily ADHD drugs - page 178
- Table 43: US physician sample breakdown, 2004 - page 209
- Table 44: Japan physician sample breakdown, 2004 - page 209
- Table 45: France physician sample breakdown, 2004 - page 210
- Table 46: Germany physician sample breakdown, 2004 - page 210
- Table 47: Italy physician sample breakdown, 2004 - page 211
- Table 48: Spain physician sample breakdown, 2004 - page 211
- Table 49: UK physician sample breakdown, 2004 - page 212
- List of Figures
- Figure 1: Prevalence, diagnosis and drug treatment rates of ADHD across the seven major markets. - page 6
- Figure 2: Prevalence and diagnosis rates of ADHD in the US - page 18
- Figure 3: Drug treatment patterns in children with ADHD in the US - page 19
- Figure 4: Drug treatment patterns in adolescents with ADHD in the US - page 20
- Figure 5: Prevalence and diagnosis rates of ADHD in Japan - page 22
- Figure 6: Drug treatment patterns in children with ADHD in Japan - page 23
- Figure 7: Drug treatment patterns in adolescents with ADHD in Japan - page 25
- Figure 8: Prevalence and diagnosis rates of ADHD in France - page 26
- Figure 9: Drug treatment patterns in children with ADHD in France - page 27
- Figure 10: Drug treatment patterns in adolescents with ADHD in France - page 28
- Figure 11: Prevalence and diagnosis rates of ADHD in Germany - page 29
- Figure 12: Drug treatment patterns in children with ADHD in Germany - page 30
- Figure 13: Drug treatment patterns in adolescents with ADHD in Germany - page 31
- Figure 14: Prevalence and diagnosis rates of ADHD in Italy - page 32
- Figure 15: Drug treatment patterns in children with ADHD in Italy - page 33
- Figure 16: Drug treatment patterns in adolescents with ADHD in Italy - page 34
- Figure 17: Prevalence and diagnosis rates of ADHD in Spain - page 35
- Figure 18: Drug treatment patterns in children with ADHD in Spain - page 36
- Figure 19: Drug treatment patterns in adolescents with ADHD in Spain - page 37
- Figure 20: Prevalence and diagnosis rates of ADHD in the UK - page 38
- Figure 21: Drug treatment patterns in children with ADHD in the UK - page 39
- Figure 22: Drug treatment patterns in adolescents with ADHD in the UK - page 40
- Figure 23: Prevalence of ADHD across the seven major markets - page 46
- Figure 24: Average age of onset of ADHD across the seven major markets - page 49
- Figure 25: Proportion of patients progressing to adult ADHD - page 50
- Figure 26: Prevalence of adult ADHD across the seven major markets - page 51
- Figure 27: Proportion of males vs. females across the seven major markets - page 52
- Figure 28: Prevalence of mood disorders across the seven major markets - page 57
- Figure 29: Prevalence of anxiety disorders across the seven major markets - page 59
- Figure 30: Prevalence of tic disorder and Tourette's syndrome across the seven major markets - page 60
- Figure 31: Prevalence of autistic and Asperger's disorder across the seven major markets - page 62
- Figure 32: Prevalence of oppositional defiant disorder and conduct disorder across the seven major markets - page 63
- Figure 33: Prevalence of substance abuse disorders across the seven major markets - page 65
- Figure 34: Prevalence of learning disabilities across the seven major markets - page 66
- Figure 35: ADHD diagnostic algorithm, 2000 - page 72
- Figure 36: Diagnosis rate of ADHD across the seven major markets. - page 81
- Figure 37: Length of time from initial presentation to diagnosis of ADHD - page 83
- Figure 38: Key findings from the UK ADDIS ADHD study - page 84
- Figure 39: A comparison of proportion of patients that consult either a PCP or psychiatrist directly or are referred - page 88
- Figure 40: Referral rates to other medical professionals by PCPs and psychiatrists - page 93
- Figure 41: AAP treatment algorithm (2001) - page 96
- Figure 42: The Texas Children's Medication Algorithm - page 97
- Figure 43: Therapy types used in the treatment of ADHD (child and adolescents) - page 118
- Figure 44: Monotherapy vs. combination therapy as a first-line treatment of ADHD - page 120
- Figure 45: Drug classes used in the first-line treatment of ADHD. - page 123
- Figure 46: Proportion of patients progressing to second-line therapy. - page 132
- Figure 47: Time from initiation of first-line therapy to progression to second-line therapy - page 132
- Figure 48: Reasons patients discontinue methylphenidate usage - page 133
- Figure 49: Second-line therapeutic strategies - page 135
- Figure 50: Drug classes used at second-line for the treatment of ADHD - page 136
- Figure 51: Key attributes most likely to influence drug choice - page 149
- Figure 52: Physician rating of drugs approved for the treatment of ADHD - page 153
- Figure 53: Child-orientated diabetes pen - page 168
- Figure 54: Child friendly Band-Aids - page 168
- Figure 55: Metadate CD marketing campaign - page 169
- Figure 56: Physician awareness of pipeline drugs - page 172
- Figure 57: Revenue of immediate-release and once-daily stimulants - page 174
- Figure 58: Datamonitor's Healthcare Consultancy - page 238
- Figure 59: Datamonitor Healthcare's Therapeutic Consulting capabilities - page 239
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