Report: Stakeholder Insight: ADHD - Prescriber Attention Still Held by Short Acting Stimulant Drugs TOC

ABOUT DATAMONITOR HEALTHCARE

About the CNS pharmaceutical analysis team

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

Japan

France

Germany

Italy

Spain

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; Î}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; INSULIN PENS; BAND-AID; MULTIVITAMINS; METADATE CD; 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

APPENDIX 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