Antipsychotic use in children plummets from 2008 to 2016

Key takeaways:

• Antipsychotic use in children aged 2 to 17 years dropped between 2008 and 2016.
• Declines were present across foster care status, age, sex, racial and ethnic groups.

The prevalence of antipsychotic use in children under Medicaid substantially declined from 2008 to 2016, according to a study published in Health Affairs.

“The remarkable increase in antipsychotic prescribing for U.S. children that took place during the early 2000s was of great concern to stakeholder, policy, and clinical communities given growing evidence of cardiometabolic risks associated with these medications, and questions about the appropriateness and management of prescribing,” Stephen Crystal, PhD, director of the Center for Health Services Research at Rutgers University and co-author of the study, told Healio. “In response, a consortium of states worked together with researchers to address the problem, benchmark rates and share promising practices. As a result, many states implemented oversight and educational initiatives for safer and more judicious prescribing, including second opinion and peer-consultation programs along with prior authorization processes, and quality metrics for safe and judicious prescribing were implemented.”

Using Medicaid administrative claims data from 2008 to 2016, Crystal and colleagues analyzed the demographics, inpatient and outpatient services, and dispensed pharmacy prescriptions for children aged 2 to 17 years.

The researchers reported that annual antipsychotic use declined by 43% from 2008 to 2016, decreasing from 2.31% to 1.32%.

While antipsychotic use remained substantially high among those in foster care compared with those not in foster care, rates of use declined in both groups. The decline was also present across all racial and ethnic groups.

The largest decline was among children aged 2 to 5 years, with use among girls decreasing from 0.17% in 2008 to 0.05% in 2016 and use in boys decreasing from 0.47% in 2008 to 0.16% in 2016.

“In light of this prior research, it has been impressive to observe the substantial declines in antipsychotic prescribing reported in the new paper over the 2008 to 2016 period, which were observed across foster care, age, sex, and racial and ethnic groups studied, as well as the declining share of prescribing that was off-label,” Crystal said. “We interpret these trends as reflecting the convergence of efforts by many states and stakeholders to encourage a more judicious approach to antipsychotic prescribing.”