{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:23:46Z","timestamp":1777922626277,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Child and Adolescent Psychopharmacology"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To assess treatment patterns, health care resource utilization, and health care costs associated with use of atypical antipsychotics (AAPs) or the nonstimulant guanfacine extended release (GXR) after stimulant therapy for attention-deficit\/hyperactivity disorder (ADHD). In Canada, GXR is approved as a monotherapy for children and adolescents with ADHD or as an adjunct to stimulants, and AAPs are commonly used off-label as an adjunct to stimulants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Health care claims data (January 1, 2007 to March 31, 2016) from Quebec's provincial health plan were assessed for individuals with ADHD, 6\u201317 years of age, who received \u22651 stimulant followed by a first AAP or GXR prescription (index medication), without a diagnosis for which AAPs are indicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Overall, 1327 individuals were included (AAPs, 1098; GXR, 229). Rates of discontinuation, augmentation, or switching of the index medication did not differ between AAPs and GXR during the first follow-up year. Discontinuation rates were significantly lower with GXR than with AAPs during the second year (22.0% vs. 35.9%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.03). GXR and AAPs resulted in similar increases in total health care cost. In GXR users, the increase in prescription drug cost after 6 months was higher than in AAP users, whereas the increase in overall medical cost was higher with AAPs than GXR, owing to more psychiatric department visits.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In children and adolescents with ADHD who used AAPs or GXR after stimulants, secondary treatment changes were similar with both treatments after 1 year, but discontinuation rates were significantly lower with GXR than with AAPs in the second year. The greater increase in prescription cost with GXR was balanced by a greater increase in overall medical costs with AAPs, resulting in no overall difference in total health care cost between the two treatments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/cap.2019.0097","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T10:57:04Z","timestamp":1566385024000},"page":"730-739","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Treatment Patterns, Health Care Resource Utilization, and Health Care Cost Associated with Atypical Antipsychotics or Guanfacine Extended Release in Children and Adolescents with Attention-Deficit\/Hyperactivity Disorder in Quebec, Canada"],"prefix":"10.1177","volume":"29","author":[{"given":"Jean","family":"Lachaine","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leila","family":"Ben Amor","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamara","family":"Pringsheim","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada."},{"name":"Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada."},{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada."},{"name":"Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Burns","sequence":"additional","affiliation":[{"name":"Shire, a Takeda company, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judy","family":"van Stralen","sequence":"additional","affiliation":[{"name":"Center for Pediatric Excellence, Ottawa, Ontario, Canada."},{"name":"Department of Paediatrics, Queen's University, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,12,2]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/1044546041649020"},{"key":"e_1_3_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/chi.0b013e3180323354"},{"key":"e_1_3_5_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/108705470000300403"},{"key":"e_1_3_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2012.02.030"},{"key":"e_1_3_5_6_1","first-page":"157","article-title":"Combination and switching of stimulants in children and adolescents with attention deficit\/hyperactivity disorder in quebec","volume":"23","author":"Ben Amor L","year":"2014","unstructured":"Ben Amor L, , Sikirica V, , Cloutier M, , Lachaine J, , Guerin A, , Carter V, , Hodgkins P, , van Stralen J: Combination and switching of stimulants in children and adolescents with attention deficit\/hyperactivity disorder in quebec. 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