Prescription Trends of Psychotropics in Children and Adolescents with Autism Based on Nationwide Health Insurance Data

Abstract

Children with autism are often medicated to manage emotional and behavioral symptoms; yet, data on such pharmacotherapy is insufficient. In this study, we investigated the Korean National Health Insurance Claims Database (NHICD) information related to autism incidence and psychotropic medication use. From the 2010–2012 NHICD, we selected a total of 31,919,732 subjects under 19 years old. To examine the diagnostic incidence, we selected patients who had at least one medical claim containing an 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for pervasive developmental disorder, F84, not diagnosed in the previous 360 days. Psychotropics were categorized into seven classes. Then, we analyzed the data to determine the mean annual diagnostic incidence and psychotropic prescription trends. Diagnostic incidence was 17,606 for the 3 years, with a mean annual incidence per 10,000 population of 5.52. Among them, 5,348 patients were prescribed psychotropics. Atypical antipsychotics were the most commonly used, followed by antidepressants. An older age, male sex, and the availability of medical aid were associated with a higher rate of prescription than observed for a younger age, female sex, and the availability of health insurance. Psychotropic drugs were used for less than one-third of patients newly diagnosed with autism, and prescription differed by sex and age. Increased diagnostic incidence is associated with an increased prescription of psychotropic drugs. Therefore, medication-related safety data and policies for psychotropic drugs in autism should be prepared.

Patterns of the Diagnosis Prevalence of Psychiatric Disorders in the Population Aged 0–18 Years Based on the Nationwide Insurance Sample Data

“…The sample size for the HIRA-PPS consisted of 10% of the entire pediatric population, which was 1,047,802 in 2010 and 932,657 in 2015, with an annual average of 989,016 ( Supplementary Table 1 in the on-line-only Data Supplement). Based on the authors’ experience of the previous analysis of 2010 NHICD [ 9 ], the present study was set from 2010. As the Korean Standard Classification of Diseases (KCD) [ 10 ] underwent a seventh revision in 2016, the study period was set to 2010–2015.…”

“…To enhance the diagnostic accuracy, patients diagnosed with a psychiatric disorder exclusively by psychiatrists were included in the analysis. As previous studies that utilized the NHICD [ 9 , 12 ] set their study population to those aged <19 years, the study population was also set to those aged <19 years to enable comparison with the authors’ previous studies. Both the main diagnosis and subdiagnosis were included, and the diagnoses were classified by the KCD [ 10 ].…”

Comparison of Services for Autism Spectrum Disorder in Massachusetts with Those in Seoul

“…In Seoul, 5,043 patients are registered with the National Registry for ASD. However, when we apply the 1.89% prevalence rate for ASD in the general population from Kim et al's study,4 Seoul has an estimated number of 28,544 children and adolescents with ASD (ages < 18 year-old), in comparison to 20,383 in Massachusetts (ages < 18 year-old) 6. In Seoul, there is a total of 29 special education schools, of which six are schools for the blind and deaf 4.…”

“…Currently, there is no consistently effective pharmacologic treatment for the core symptoms of ASD 6. Early identification and early intensive behavioral interventions are believed to improve outcomes for the disorder 78.…”

Incidence and Comorbidity of Reactive Attachment Disorder: Based on National Health Insurance Claims Data, 2010–2012 in Korea

“…The Korean National Health Insurance (NHI) claims database maintained by the Health Insurance Review and Assessment Service (HIRA) is a database containing all medical and prescription drug claim records for the Korean population [ 13 ]. According to the claims data from 2015, approximately 50,490,157 individuals (97.1%) had National Health Insurance (NHI), while 1,544,267 individuals (2.9%) had medical aid [ 14 ]. HIRA claims data are a record of national insurance claims by a physician based on patient treatment records, and the diagnostic codes are determined by the clinician after treating the patient.…”