Methylphenidate and atomoxetine prescribing trends in children in the Western Cape Province of South Africa, 2005-2013

Background: There is paucity of data on methylphenidate and atomoxetine prescribing patterns in South African children. Aim: To describe the prescribing trends of these agents in children residing in the Western Cape Province. Setting: South African private health sector. Methods: Longitudinal drug utilisation study on medicine claims data from 2005-2013, focussing on the number of patients and prescriptions per patient. Results: The total number of patients increased by 29.5% from 2005 to 2013. The majority were boys (male:female ratio, 3.5:1), and between the ages of > 6 and <= 12 years in 2005 and >12 and <= 18 years in 2013. More than 75% of patients received methylphenidate or atomoxetine in the City of Cape Town Metropolitan municipality. Prescriptions for methylphenidate and atomoxetine increased by 45.5% overall from 2005 to 2013 (p < 0.001), with that for methylphenidate and atomoxetine increasing by 36.0% and 314.5%, respectively. The average number of annual methylphenidate prescriptions per patient increased from 3.96 +/- 2.92 (95% CI, 3.69-4.23) in 2005 to 4.38 +/- 2.85 (95% Cl, 4.14-4.61) in 2013 (Cohen's d = 0.14) and for atomoxetine from 2.58 +/- 1.86 (95% CI, 1.80-3.37) in 2005 to 4.85 +/- 3.66 (95% CI, 3.84-5.86) in 2013 (Cohen's d = 0.62). Conclusion: Although the total number of patients and prescribing of methylphenidate and atomoxetine increased significantly from 2005 to 2013, a slight downward trend was observed in the mean number of prescriptions per patient per year from 2008 onwards. These prescribing patterns warrant further research.