Home | Publications | Therapeutic | CNS / Neurology place holder
place holder place holder

CNS / Neurology

Stakeholder Insight: ADHD

Prescriber Attention Still Held by Short Acting Stimulant Drugs

Publication Date   September 2004
Publisher   Datamonitor
Product Type   Report
Pages   241
ISBN Number   not applicable
Product Code   DAT211
Ask a question about this product?

Price £8,000.00

approximately: $11,929 | €9,530

Summary


Introduction

Despite the plethora of once-daily drugs available for the treatment of ADHD, physicians consistently prescribe immediate release formulations. To bolster revenues, manufacturers must continue to promote awareness of ADHD at all levels, but most also seek to further differentiate their once-daily products from generics and other branded products in the eyes of both the patient and the physician.

Scope of this report

  • Analysis is based on a survey of 180 prescribing physicians in the seven major markets as well as in-depth interviews with ADHD Key Opinion Leaders
  • Detailed treatment trees showing the prevalence, diagnosis and treatment rates of ADHD across the seven major markets
  • Analyzes the first and second-line treatment of children and adolescents with ADHD
  • Identifies diagnostic and therapeutic unmet needs, highlights how manufacturers can drive patient identification as well as bolster drug prescriptions

Research and analysis highlights

Datamonitor primary research has identified variances in class- and brand-prescribing preferences among physicians, although prescribing trends generally follow recognized national and international guidelines. However, there is concern over the use of combination therapies in the absence of conclusive clinical trial data.Only 12.3% of patients are diagnosed, indicating that a huge proportion of patients remain undiagnosed and untreated. Although the awareness of ADHD is ever growing, there are still significant gaps between, knowledge, recognition and referral of the disease. Datamonitor has highlighted these and provides counteractive strategic recommendations.Only 20% of patients receive longer-acting, once-daily drugs at first-line, falling to 3% at second-line, with physicians preferring immediate-release formulations. Consequently, Datamonitor has identified numerous lifecycle strategies to bolster long-acting drug sales.

Key reasons to read this report

  • Identify commercial opportunities by benchmarking current products and assessing unmet needs and future market potential
  • Assess the size of the drug-treated population through an understanding of the prevalence of ADHD with comorbid psychiatric and behavioral disorders
  • Communicate with physicians more effectively, through an understanding of prescribing behavior

Content


  • Chapter 1 Executive Summary
    • Scope of the analysis
    • Datamonitor insight into the ADHD market
    • Key metrics
  • Chapter 2 Introduction And Scope
    • Coverage of the Stakeholder Insight Survey
    • Epidemiology and diagnosis of ADHD
    • Referral patterns
    • Treatment of ADHD
    • Drug profiles
  • Chapter 3 Country Treatment Trees
    • US
    • Japan
    • France
    • Germany
    • Italy
    • Spain
    • UK
  • Chapter 4 Epidemiology & Patient Segmentation
    • Key findings
    • Disease definition and classification
    • Etiology of ADHD
    • Structural abnormalities
    • Genetic predisposition
    • Neurotransmitter dysfunction
    • Diagnostic criteria of ADHD
    • Epidemiology of ADHD
    • Prevalence of ADHD
    • Age of onset of ADHD
    • Progression to adult ADHD
    • Key patient segments
    • Gender
    • Comorbidities
    • Mood disorders and depression
    • Anxiety disorders
    • Tic disorder and Tourette's syndrome
    • Autistic and Asperger's disorder
    • Oppositional defiant disorder and conduct disorder
    • Substance abuse
    • Learning disabilities
  • Chapter 5 Diagnosis And Treatment Options
    • Key findings
    • Diagnostic guidelines
    • Summary of DSM-IV criteria for the diagnosis of ADHD
    • Summary of ICD-10 criteria for the diagnosis of HKD
    • ADHD diagnostic algorithm
    • Diagnostic complications
    • Hyperkinesis versus attention deficit hyperactivity disorder
    • Gender
    • Age
    • Duration of symptoms
    • Diagnostic tools
    • ADHD Rating Scale
    • Copeland symptom checklist
    • Barkley's Current Symptoms Scale-Self Report Form (home and school)
    • Brown ADD Scale (diagnostic form)
    • Parent-completed Child Behavior Checklist
    • Teacher Report Form (TRF) of Child Behavior Checklist
    • ADD-H: Comprehensive Teacher Rating Scale (ACTeRS)
    • Frequency of diagnostic tool usage
    • Diagnosis rates
    • Time to diagnosis
    • Diagnostic unmet needs
    • Referral patterns
    • Direct consultations
    • Referral patterns of interviewed physicians
    • Types of medical professional referred to
    • Treatment planning
    • Treatment guidelines
    • AAP guidelines
    • The Texas Children's Medication Algorithm
    • UK NICE guidelines
    • Pharmacological treatments
    • Stimulants
    • Amphetamines
    • Adderall and Adderall XR
    • Dextroamphetamines
    • Dexedrine and Dexedrine SR/Spansule
    • Dextrostat
    • Methylphenidate
    • Ritalin
    • Focalin
    • Metadate
    • Methylin
    • Concerta
    • Cylert
    • Non-stimulants
    • Strattera
    • Drugs prescribed off label
    • Antidepressants
    • ?2-agonists
    • Antipsychotics
    • Non-pharmacological therapy
    • Economic consequences
  • Chapter 6 Prescribing Trends And Influencing Factors
    • Key findings
    • Introduction
    • Prescribing trends
    • Pharmacological versus non-pharmacological therapy
    • First-line treatment strategies
    • Drug classes prescribed in first-line therapy
    • Drugs prescribed in first-line therapy
    • Children
    • Adolescents
    • Immediate- versus modified-release drugs
    • Country-specific first-line therapy
    • US
    • Japan
    • Progression to second-line therapy
    • Second-line treatment strategies
    • Drug classes prescribed in second-line therapy
    • Second-line add-on strategies
    • Immediate- versus modified-release drugs in add-on therapy
    • Drugs used in second-line add-on therapy
    • Second-line switch strategies
    • Immediate- versus modified-release drugs in switch therapy
    • Drugs used in second-line switch therapy
    • US
    • Japan
    • Europe
    • Factors influencing physician decision making
    • Drug attributes
    • Parent and patient influence
    • Product profiles
  • Chapter 7 Improving Treatment Outcomes
    • Key findings
    • Unmet needs of ADHD
    • Longer-acting therapies
    • How to improve the perceived efficacy and uptake of longer-acting therapies
    • Zinc
    • Immediate- and modified-release combinations
    • Pharmacokinetics
    • Novel formulations
    • Advocacy initiatives
    • National ADHD Awareness Day
    • New product development
    • Methypatch (transdermal methylphenidate)
    • Focalin LA (dexmethylphenidate)
    • SPD-503
    • Provigil (modafinil)
    • ABT-089
    • NS-2359
    • Recently discontinued drugs
    • SPD473
  • Chapter 8 Opinion Leader Transcripts
    • KOL 1
    • KOL 2
    • PPENDIX A
    • Bibliography
    • Websites
  • Appendix B
    • Physician sample breakdown
    • Physician research methodology
    • Contributing experts
  • Appendix C
    • Physician questionnaire
    • Report methodology
    • Date of research completion
    • About Datamonitor
    • About Datamonitor Healthcare
    • Datamonitor Healthcare's research and analysis methodologies
    • Datamonitor Healthcare's therapy area capabilities
    • About the CNS analysis team
    • Datamonitor Healthcare's Consulting expertise
    • Datamonitor's Therapeutic Consulting expertise
    • Key therapy team members
    • Lynda Lynch, Director CNS
    • David Abramson, Therapeutic Lead Consultant
    • Disclaimer
  • List of Tables
    • Table 1: Patients diagnosed with ADHD across the seven major markets (2004 to 2010) (000s).
    • Table 2: Symptoms for ADHD/HKD in the DSM-IV and ICD-10
    • Table 3: Definition of ADHD in the DSM-IV
    • Table 4: Prevalence of ADHD across the seven major markets
    • Table 5: Prevalence of ADHD
    • Table 6: Proportion of males vs. females across the seven major markets
    • Table 7: Prevalence of comorbid disorders in ADHD (%)
    • Table 8: DSM-IV categorization of ADHD.
    • Table 9: ICD-10 categorization of hyperkinetic disorders
    • Table 10: Frequency of diagnostic tool usage (%)
    • Table 11: Diagnostic tools used by PCPs vs. Psychiatrists (%)
    • Table 12: Prevalence breakdown of ADHD across the seven major markets (2004)
    • Table 13: Professionals who make diagnoses of ADHD
    • Table 14: Proportion of patients referred to another physician type
    • Table 15: Proportion of patients referred to other medical professionals by PCPs
    • Table 16: Proportion of patients referred to other medical professionals by psychiatrists
    • Table 17: Stimulants approved for the treatment of ADHD
    • Table 18: Non-stimulants approved for the treatment of ADHD
    • Table 19: Drugs used off label for the treatment of ADHD
    • Table 20: Therapy types used in the treatment of ADHD
    • Table 21: Drugs used in first-line monotherapy in children across the seven major markets (%)
    • Table 22: Drugs used in first-line monotherapy in adolescents across the seven major markets (%)
    • Table 23: Immediate- vs. modified-release drugs prescribed in children at first-line across the seven major markets
    • Table 24: Immediate- vs. modified-release drugs prescribed in adolescents at first-line across the seven major markets
    • Table 25: Top three drugs prescribed for the treatment of ADHD in children across the seven major markets
    • Table 26: Top three drugs prescribed for the treatment of ADHD in adolescents across the seven major markets
    • Table 27: Add-on strategies in the second-line treatment of children with ADHD
    • Table 28: Add-on strategies in the second-line treatment of adolescents with ADHD
    • Table 29: Immediate- vs. modified-release drugs prescribed to children and adolescents in second-line add-on therapy across the seven major markets
    • Table 30: Second-line add-on therapy in children and adolescents
    • Table 31: Top three drugs prescribed for the treatment of ADHD in children and adolescents across the seven major markets
    • Table 32: Switching strategies in the second-line treatment of children with ADHD
    • Table 33: Switching strategies in the second-line treatment of adolescents with ADHD
    • Table 34: Immediate- vs. modified-release drugs prescribed to children at second-line switch therapy across the seven major markets
    • Table 35: Immediate- vs. modified-release drugs prescribed to adolescents at second-line switch therapy across the seven major markets
    • Table 36: Second-line switch therapy children
    • Table 37: Second-line switch therapy adolescents
    • Table 38: Top three drugs prescribed to children in second switch therapy across the seven major markets
    • Table 39: Top three drugs prescribed to adolescents in second switch therapy across the seven major markets
    • Table 40: Top three drugs characterized by physicians across the seven major markets
    • Table 41: ADHD pipeline products, 2004
    • Table 42: Price of Provigil and marketed once-daily ADHD drugs
    • Table 43: US physician sample breakdown, 2004
    • Table 44: Japan physician sample breakdown, 2004
    • Table 45: France physician sample breakdown, 2004
    • Table 46: Germany physician sample breakdown, 2004
    • Table 47: Italy physician sample breakdown, 2004
    • Table 48: Spain physician sample breakdown, 2004
    • Table 49: UK physician sample breakdown, 2004
  • List of Figures
    • Figure 1: Prevalence, diagnosis and drug treatment rates of ADHD across the seven major markets.
    • Figure 2: Prevalence and diagnosis rates of ADHD in the US
    • Figure 3: Drug treatment patterns in children with ADHD in the US
    • Figure 4: Drug treatment patterns in adolescents with ADHD in the US
    • Figure 5: Prevalence and diagnosis rates of ADHD in Japan
    • Figure 6: Drug treatment patterns in children with ADHD in Japan
    • Figure 7: Drug treatment patterns in adolescents with ADHD in Japan
    • Figure 8: Prevalence and diagnosis rates of ADHD in France
    • Figure 9: Drug treatment patterns in children with ADHD in France
    • Figure 10: Drug treatment patterns in adolescents with ADHD in France
    • Figure 11: Prevalence and diagnosis rates of ADHD in Germany
    • Figure 12: Drug treatment patterns in children with ADHD in Germany
    • Figure 13: Drug treatment patterns in adolescents with ADHD in Germany
    • Figure 14: Prevalence and diagnosis rates of ADHD in Italy
    • Figure 15: Drug treatment patterns in children with ADHD in Italy
    • Figure 16: Drug treatment patterns in adolescents with ADHD in Italy
    • Figure 17: Prevalence and diagnosis rates of ADHD in Spain
    • Figure 18: Drug treatment patterns in children with ADHD in Spain
    • Figure 19: Drug treatment patterns in adolescents with ADHD in Spain
    • Figure 20: Prevalence and diagnosis rates of ADHD in the UK
    • Figure 21: Drug treatment patterns in children with ADHD in the UK
    • Figure 22: Drug treatment patterns in adolescents with ADHD in the UK
    • Figure 23: Prevalence of ADHD across the seven major markets
    • Figure 24: Average age of onset of ADHD across the seven major markets
    • Figure 25: Proportion of patients progressing to adult ADHD
    • Figure 26: Prevalence of adult ADHD across the seven major markets
    • Figure 27: Proportion of males vs. females across the seven major markets
    • Figure 28: Prevalence of mood disorders across the seven major markets
    • Figure 29: Prevalence of anxiety disorders across the seven major markets
    • Figure 30: Prevalence of tic disorder and Tourette's syndrome across the seven major markets
    • Figure 31: Prevalence of autistic and Asperger's disorder across the seven major markets
    • Figure 32: Prevalence of oppositional defiant disorder and conduct disorder across the seven major markets
    • Figure 33: Prevalence of substance abuse disorders across the seven major markets
    • Figure 34: Prevalence of learning disabilities across the seven major markets
    • Figure 35: ADHD diagnostic algorithm, 2000
    • Figure 36: Diagnosis rate of ADHD across the seven major markets.
    • Figure 37: Length of time from initial presentation to diagnosis of ADHD
    • Figure 38: Key findings from the UK ADDIS ADHD study
    • Figure 39: A comparison of proportion of patients that consult either a PCP or psychiatrist directly or are referred
    • Figure 40: Referral rates to other medical professionals by PCPs and psychiatrists
    • Figure 41: AAP treatment algorithm (2001)
    • Figure 42: The Texas Children's Medication Algorithm
    • Figure 43: Therapy types used in the treatment of ADHD (child and adolescents)
    • Figure 44: Monotherapy vs. combination therapy as a first-line treatment of ADHD
    • Figure 45: Drug classes used in the first-line treatment of ADHD.
    • Figure 46: Proportion of patients progressing to second-line therapy.
    • Figure 47: Time from initiation of first-line therapy to progression to second-line therapy
    • Figure 48: Reasons patients discontinue methylphenidate usage
    • Figure 49: Second-line therapeutic strategies
    • Figure 50: Drug classes used at second-line for the treatment of ADHD
    • Figure 51: Key attributes most likely to influence drug choice
    • Figure 52: Physician rating of drugs approved for the treatment of ADHD
    • Figure 53: Child-orientated diabetes pen
    • Figure 54: Child friendly Band-Aids
    • Figure 55: Metadate CD marketing campaign
    • Figure 56: Physician awareness of pipeline drugs
    • Figure 57: Revenue of immediate-release and once-daily stimulants
    • Figure 58: Datamonitor's Healthcare Consultancy
    • Figure 59: Datamonitor Healthcare's Therapeutic Consulting capabilities