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The article by Bachmann et al. (1) attempts to answer two questions regarding healthcare service utilization related to attention-deficit/ hyperactivity disorder (ADHD) in Germany.
- What is the diagnosis and (drug) therapy prevalence during 2009–2014?
- What is the medication provision for affected adolescents until they reach adulthood (“transition”)?
To answer the first question, the article offers an update on the data on the administrative prevalence, including pharmacotherapy, of ADHD in Germany. The strength of the study is primarily its sample size, but it is not necessarily representative. The authors compare two data points, and on this basis they draw conclusions about trends that—because of the unusual inclusion of the very heterogeneous ICD category F98.8 [other specified behavioral and emotional disorders of childhood and adolescence, including excessive masturbation and nose-picking]—can be compared with earlier studies to a limited extent only.
To answer the second question, the authors conducted a longitudinal analysis of 5593 patients insured with the statutory health insurance company, AOK, for whom a diagnosis of ADHD at age 15 was coded in 2009 (or 2008? cf. Figure 3 in the article). What remains unclear is whether these are newly diagnosed patients with ADHD (which can be determined on the basis of a minimum number of previous billing quarters without ADHD diagnosis). It also remains unclear whether medication therapy was assumed already after one prescription only during a calendar year. Earlier analyses showed that (from 2006 to 2009) 51% of ADHD patients were prescribed typical ADHD drugs, but that in the majority of cases therapy was discontinued before 18 months had passed. The absence of a (methodologically feasible) control group hampers or even completely prevents not only an evaluation stratified by comorbidity or relevant non-medication and combination therapies (2, 3), but also any interpretation of the data of the “transition cohort“ itself (including subjects’ contacts with physicians over time), as their specificity must remain speculative.
Prof. Dr. med. Michael Schlander, MBA
Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
Prof. Dr. rer. pol. Oliver Schwarz
Prof. Dr. med. Götz-Erik Trott
Praxis Trott Aschaffenburg
Conflict of interest statement
Prof. Schlander holds shares in Johnson & Johnson. He has received author honoraria for book publications on the subject from Springer and study funding/support from Shire and Janssen-Cilag.
Prof. Trott has received lecture fees from Shire.
Prof. Schwarz declares that no conflict of interest exists.
|1.||Bachmann CJ, Philipsen A, Hoffmann F: ADHD in Germany: trends in diagnosis and pharmacotherapy—a country-wide analysis of health insurance data on attention-deficit/hyperactivity disorder (ADHD) in children, adolescents and adults from 2009–2014. Dtsch Arztebl Int 2017; 114: 141–8 VOLLTEXT|
|2.||Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie und Psychotherapie et al. (ed.): Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter. Köln: Deutscher Ärzteverlag, 3. überarbeitete Auflage 2007; 239–54.|
|3.|| Schlander M, Schwarz O, Trott GE, Banaschewski T: ADHD: a longitudinal analysis (2003–2009) of prevalence, health care, and direct cost based upon administrative data from Nordbaden/Germany. Eur Child Adolesc Psychiatry 2013; 22 (S2): 102. |