Stimulants Concomitant with Other Psychotropic Classes: A Competing Risk Analysis in Medicaid-Insured Youth

Area of Science:

• Pharmacoepidemiology
• Pediatric Psychopharmacology
• Health Services Research

Background:

• Increasing use of polypharmacy for behavioral treatment in youth.
• Need for precise methods to analyze psychotropic medication patterns over time.
• Limited exploration of competing risk analysis in stimulant treatment changes.

Purpose of the Study:

• To explore psychotropic patterns of concomitant stimulant treatment changes over time using competing risk analysis.
• To assess patient factors associated with changes in the number of psychotropic classes (NPC).
• To analyze time factors related to changes in NPC among youth.

Main Methods:

• Retrospective cohort study using Medicaid enrollment, prescription drug, and diagnosis claims data (2007-2014).
• Followed new stimulant users aged 2-17 years with continuous enrollment.
• Utilized competing risk analysis to assess NPC changes and associated patient/time factors.

Main Results:

• 24.5% of 30,294 new stimulant users had concomitant psychotropic regimens with substantial temporal flux.
• Median duration decreased as NPC increased (223 days for 2 classes to 113 days for 5 classes).
• Competing risk analysis identified increased hazard ratios for older youth, foster care/disability coverage, and specific enrollment durations.

Conclusions:

• Detailed NPC changes show significant flux in concomitant stimulant patterns among Medicaid-insured youth.
• Competing risk analysis provides more precise risk information for NPC changes compared to binary models.
• This approach enhances understanding of complex polypharmacy in pediatric stimulant treatment.