6 Implications for the NHS
6.1 Prescribing of stimulant drugs for ADHD has steadily increased in recent years. In 1998 there were approximately 220,000 prescriptions in England for stimulant drugs (methylphenidate and dexamfetamine) at a net ingredient cost of about £5 million; in 2004 the number of prescriptions for these drugs had almost doubled to 418,300 at a cost of almost £13 million. In 1998 there were no licensed modified-release formulations of methylphenidate, and the use of unlicensed formulations accounted for only a tiny proportion of stimulant prescriptions. In 2004, modified-release formulations accounted for 54% of all methylphenidate prescriptions and 79% of the total net ingredient costs for this drug. Atomoxetine was licensed in the UK in May 2004. In 2004 there were approximately 15,500 prescriptions for atomoxetine in England at a cost of £1.2 million. It is not anticipated that this guidance will result in a major increase over current trends in the rate of prescribing for ADHD.
6.2 Atomoxetine and the modified-release formulations of methylphenidate are more expensive than immediate-release formulations of dexamfetamine and methylphenidate. The costs associated with treatment monitoring are likely to be highest during the initial titration stages as doses are adjusted. The immediate-release formulations are often used at this stage because of the greater flexibility in dosage increments.
6.3 This guidance is not likely to have a significant impact on other resources. However, any increase in the uptake of modified-release methylphenidate and once-daily atomoxetine regimens may reduce the need to administer in-school doses of immediate-release methylphenidate and dexamfetamine.