Stimulants and Atomoxetine Use and Expenditures in Children and Adolescents in the United States



  • Rajender R. Aparasu
  • V Bhatara


This study examined national level prevalence and expenditure patterns of stimulants and atomoxetine in children and adolescents in the United States.  The 2003-2004 Medical Expenditure Panel Survey (MEPS) data were used to examine the utilization pattern of stimulants (amphetamine, dextroamphetamine, methylphenidate, and dexmethyl-phenidate) and atomoxetine in persons less than 20 years of age. Annual population, prescription, and expenditure estimates including 95% confidence intervals (CI) were derived after adjusting for the complex survey design of the MEPS.  Prescription expenditures in the MEPS represent the amount paid to pharmacies from all sources, including payments by insurance and patients. The expenditures were adjusted to 2004 US dollar using the Consumer Price Index.   In 2003-2004, an estimated 2.67 million (95% CI, 2.30 - 3.03 million) children and adolescents used stimulants or atomoxetine annually for an overall prevalence of 3.19% (95% CI, 2.78 - 3.60). Prevalence of stimulants alone was 2.78% (95% CI, 2.39-3.17%) with methylphenidates accounting for most of the usage. Children and adolescents using stimulants or atomoxetine were most often males (70%), whites (86%), and 10-14 years of age (52%). Nearly 90% of them reported an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis. Annual expenditures for stimulants and atomoxetine were estimated at $1.69 billion (95% CI, $1.40 - 1.98 billion), with stimulants representing 79% of the expenditure. The average prescription cost was highest ($99.48) for atomoxetine and lowest ($75.70) for methylphenidates. Atomoxetine accounted for one-fourth of the prevalence and one-fifth of the expenditures in children.  In conclusion, although stimulants accounted for most of the usage and expenditures, atomoxetine has emerged as the leading stimulant alternative in children and adolescents. High prescription costs and utilization patterns for atomoxetine are likely to influence future prescription expenditure burdens in pediatric ADHD. More research is needed on the relative cost and effectiveness of various stimulant preparations and atomoxetine.   


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Stimulants, atomoxetine, prevalence, children and adolescents




How to Cite

Aparasu RR, Bhatara V. Stimulants and Atomoxetine Use and Expenditures in Children and Adolescents in the United States. Scopus Indexed [Internet]. 2011 Aug. 31 [cited 2024 Jun. 20];4(2):1428-32. Available from:



Research Articles


Bhatara V and Aparasu R (2007). Pharmacotherapy with atomoxetine for US children and adolescents. Ann Clin Psychaitry 19(3):175-80.

Cheng JY, Chen RY, Ko JS and Ng EM (2007). Efficacy and safety of atomoxetine for attention-deficit/hyperactivity disorder in children and adolescents-meta-analysis and meta-regression analysis. Psychopharmacology 194(2):197-209.

MEPS (2008a). 2003-2004 Medical Expenditure Panel Survey Full Year Population Characteristics and Prescribed Medicines Files. Rockville, Md, Agency for Healthcare Research and Quality. Available at Date retrieved March 5, 2008.

MEPS (2008b). 2003-2004 Medical Expenditure Panel Survey: Survey Instruments and Associated Documentation. Agency for Healthcare Research and Quality, Rockville, MD. Available at: Date retrieved March 5, 2008.

Olfson M, Gameroff MJ, Marcus SC and Jensen PS (2003). National trends in the treatment of attention deficit hyperactivity disorder. Am J Psychiatry 160(6):1071-7.

Pliszka SR,Bernet W, Buckstein O, Walter H, et al (2007). Practice parameters for the assessment and treatment of children and adolescent with Attention Deficit/ Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 46: 894-921.

USFDA (2003). U.S. Food and Drug Administration: Strattera approved to treat ADHD. FDA Consum 2003, 37:4.

USDL (2008). U.S. Department of Labor, Bureau of Labor Statistics, Consumer Price Index. Available at: Date retrieved March 5, 2008.

Zito JM, Safer DJ, dosReis S, et al (2000). Trends in the prescribing of psychotropic medications to preschoolers. JAMA 283(8):1025-30.

Zuvekas SH, Vitiello B and Norquist GS (2006). Recent trends in stimulant medication use among U.S. children. Am J Psychiatry 163(4):579-85.