JMIR Publications

ABSTRACT

Background:

Stimulants are potent treatments for Central Hypersomnolence Disorders (CHD) or Attention Deficit Disorders (ADHD/ADD) but concerns have been raised about their potential negative consequences and their increasing prescription rates.

Objective:

We aimed to describe stimulant prescription trends in Switzerland and to analyze the association of stimulants with hospitalization using a large health insurance claims database.

Methods:

Longitudinal and cross-sectional data from a large Swiss health care insurance were analyzed from all insurees older than 6 years. Results were extrapolated to the Swiss general population. We identified prescriptions for methylphenidate, lisdexamfetamine, modafinil and sodium oxybate and generated descriptive statistics for prevalence calculations of each drug prescription over the period from 2014 to 2021. For 2021 we provide detailed information on the prescribers of stimulants and evaluate the association of stimulant prescription and the number and duration of hospitalization using logistic regression models.

Results:

We found increasing prescription rates of all stimulants in all age groups from 2014 to 2021 (0.6% to 0.8%, 43 848 to 66 113 insurees with a prescription). In 2021, 37.1% (28 057 prescriptions) of the medications were prescribed by psychiatrists, followed by 36.1% (27 323) prescribed by general practitioners (GP) and 1% (748) by neurologists. Only sodium oxybate which is highly specific for narcolepsy treatment was most frequently prescribed by neurologists (27.8%, 37 prescriptions). Most common comorbidities of stimulant receivers were psychiatric diseases with 50-60%. Patients hospitalized in a psychiatric institution in 2021 were 5.3 times (odds ratio [OR]:5.30, 95% confidence interval [CI]: 4.63-6.08, p-value <0.001) more likely to have a stimulant prescription than those without hospitalization. In contrast, there was a negative association between stimulant prescription and hospitalization in an acute medical care facility (OR: 0.77, 95% CI: 0.73-0.82, p-value <0.001). There were no significant associations between stimulant prescription and the total length of inpatient stay (OR: 1.00, 95% CI: 1.00-1.00, p-value = 0.13).

Conclusions:

The prescription of stimulant medication in Switzerland increased slightly but continuously over the past years, but at lower rates compared to the estimated prevalence of CHD and ADHD/ADD. Most stimulants are prescribed by psychiatrists, closely followed by GPs. The increased odds for hospitalization to psychiatric institutions for stimulant receivers reflects the severity of disease and the higher psychiatric comorbidities in these patients.