An Economic & Policy Analysis of ADHD & Stimulant Drugs

描述(由申请人提供)：这项研究提供了对注意力缺陷多动障碍(ADHD)精神刺激剂使用变化的经济和政策分析。ADHD是儿童中最常见的行为障碍。根据疾病控制中心(CDC)2002年的一份报告，在美国，大约3.5%的学龄儿童被诊断为ADHD，超过一半的被诊断为ADHD的人定期服用精神兴奋剂药物。这些药物的使用差异很大，在各州之间高达三倍，在州内高达十倍。这个项目的主要目标是了解这些巨大变化的经济和政策来源。使用汇总数据和对本地市场的不同定义，我们检验了美国大陆消费率差异的来源。市场模型被用来检验关于经济、人口统计(例如，年龄、性别、种族、民族)、州监管、学校政策、卫生系统和其他教育变量对精神兴奋剂供需的影响的假设。令人感兴趣的政策变量的例子包括关于处方药替代和再灌装的州一级法规、附表2药物监测计划以及学校责任法。然后，我们使用更详细的加州消费率数据重复分析。这一分分析解释了性别和年龄组之间的差异以及学区一级教育政策差异的影响。接下来，我们使用北加州Kaiser-Permanente的纵向数据来研究个体水平成本和利用模式的差异来源。我们使用Kaiser的数据来检验个人特征(年龄、性别、种族/民族、出生体重、母亲出生时的年龄)和当地特征(经济、人口、医疗和保险市场以及学区教育政策)对治疗患有ADHD儿童的费用的影响。此外，我们使用Kaiser数据来检验这些变量对精神兴奋剂使用的“咒语”的影响，包括对精神兴奋剂药物的开始、停止和重新开始的影响。在这项研究中，我们将梳理影响美国各地精神兴奋剂使用差异很大的经济和政策因素。通过进一步了解这种差异，结果将告知政策制定者、卫生专业人员、教育工作者和有学龄儿童的家庭。

DESCRIPTION (provided by applicant): This research provides an economic and policy analysis of the variation in psycho-stimulant use for Attention Deficit Hyperactivity Disorder (ADHD). ADHD is the most commonly diagnosed behavioral disorder in children. According to a 2002 Centers for Disease Control (CDC) report, roughly 3.5 percent of school-age children in the U.S. have an ADHD diagnosis, and over half of those diagnosed with ADHD take psycho-stimulant medication regularly. Use of these drugs varies considerably, up to three-fold across states and ten-fold within states. The main goal of this project is to understand the economic and policy sources of these dramatic variations. Using aggregate data and different definitions of local markets, we examine the sources of variation in the consumption rates across the continental U.S. The market models are used to test hypotheses regarding the effects of economic, demographic (e.g. age, sex, race, ethnicity), state regulatory, school policy, health system, and other educational variables on the supply and demand for psycho-stimulants. Examples of policy variables of interest include state level regulations on substitution and refilling of prescription drugs, Schedule II drug monitoring programs, as well as school accountability laws. We then repeat the analysis using more detailed data on consumption rates in California. This sub-analysis explains the variation within gender and age groups and the impact of differences in educational policies at the school district level. Next, we study the sources of variation in individual-level cost and utilization patterns using longitudinal data from Kaiser-Permanente Northern California. We use the Kaiser data to examine the effects of personal characteristics (age, gender, race/ethnicity, birth weight, mother's age at birth), and local area characteristics (economic, demographic, medical and insurance market and school district education policies) on costs of treating children with ADHD diagnoses. Additionally we use the Kaiser data to examine the effects of these variables on "spells" of psycho-stimulant use, including effects on the initiation, discontinuation, and restarting of psycho-stimulant drugs. In this study we will sort through the economic and policy factors influencing the large variation in psycho-stimulant use across the U.S. By furthering the understanding of this variation, the results will inform policymakers, health professionals, educators, and families with school-age children.