[영문]BACKGROUND: Many therapies exist for treating adult attention-defi cit/hyperactivitydisorder (ADHD), also referred to as attention-defi cit disorder (ADD),but there is no research regarding cost differences associated with initiatingalternative ADD/ADHD drug therapies in adults.OBJECTIVE: To compare from the perspective of a large self-insured employerthe risk-adjusted direct health care costs associated with 3 alternative drugtherapies for ADD in newly treated patients: extended-release methylphenidate(osmotic release oral system-MPH), mixed amphetamine salts extendedrelease (MAS-XR), or atomoxetine.METHODS: We analyzed data from a US claims database of 5 millionbenefi ciaries from 31 large self-insured employers (1999-2004). Analysis wasrestricted to adults aged 18 to 64 years with at least 1 diagnosis of ADD/ADHD(International Classifi cation of Diseases, Ninth Revision, Clinical Modifi cation[ICD-9-CM] codes 314.0x?attention defi cit disorder; 314.00?attentiondeficit disorder without hyperactivity; or 314.01?attention-defi cit disorderwith hyperactivity) and at least 1 pharmacy claim for OROS-MPH, MAS-XR,or atomoxetine identifi ed using National Drug Codes. In preliminary analysis,we calculated the duration of index ADHD drug therapy as time from indextherapy initiation to a minimum 60-day gap. Because the median duration ofindex ADHD drug therapy was found to be approximately 90 days, the primarymeasures were total direct medical plus drug costs and medical-only costscomputed over 6 months following therapy initiation. Adults were requiredto have continuous eligibility 6 months before and 6 months after their latestdrug therapy initiation and no ADHD therapy during the previous 6 months.Cost was measured as the payment amount made by the health plan to theprovider rather than billed charges, and it excluded patient copayments anddeductibles. Medical costs included costs incurred for all-cause inpatientand outpatient/other services. Costs were adjusted for infl ation to 2004 U.S.dollars using the consumer price index for medical care. T tests were usedfor descriptive cost comparisons. Generalized linear models (GLMs) wereused to compare costs of adults receiving alternative therapies, adjusting fordemographic characteristics, substance abuse, depression, and the CharlsonComorbidity Index.RESULTS: Of the 4,569 patients who received 1 of these 3 drug therapiesfor ADHD, 31.8% received OROS-MPH for a median duration of 99 days oftherapy, 34.0% received MAS-XR for a median 128 days, and 34.2% receivedatomoxetine for a median 86 days. In the 6-month follow-up period, the mean(standard deviation) total medical and drug costs were