Cost Savings Associated With Therapeutic Exchange of Stimulant Medications

Drug Topics JournalDrug Topics January 2023
Volume 167
Issue 01

Cost savings were not associated with an increase in adverse drug events.

A therapeutic exchange initiative from lisdexamfetamine to amphetamine/dextroamphetamine extended-release (ER) led to a significant decrease in the overall costs of long-acting stimulant medications, according to the results of a poster1 presented at the American Society of Health-System Pharmacists 2022 Midyear Clinical Meeting, held December 4 to 8 in Las Vegas, Nevada.

Researchers conducted a single-center, retrospective cohort study at a 55-bed rural pediatric and adolescent behavioral health facility. Participants were between ages 5 and 17 and were admitted to the acute program and residential treatment center. A Pharmacy and Therapeutics Committee developed a therapeutic interchange chart of equivalent doses for both medications, and a 6-month transitional period was allotted before postimplementation data were collected.

The primary study outcomes were the difference in cost per patient day for long-acting amphetamine stimulants and adverse drug events that affected quality of patient care. The secondary outcome was determining if there was a significant difference in prescribing patterns, based on doses per patent for day, for immediate-release and extended-release stimulants.

After the initiation of a long-acting amphetamine therapeutic interchange, the cost per patient day decreased by 94% ($3.09 vs $0.18) with no change in adverse drug events pre- or post-implementation. Doses of immediate-release stimulants per patient day increased by 86% overall, with specific increases of 79% for dexmethylphenidate and 124% for amphetamine/dextroamphetamine—both significant increases.

There was no statistically significant difference in extended-release stimulant doses per patient day, with a decrease of 12% overall. Doses of lisdexamfetamine decreased by 100%—a significant decrease, per researchers—while methylphenidate ER and amphetamine/dextroamphetamine ER significantly increased by 77% and 336%, respectively.

“Implementation of a therapeutic interchange of lisdexamfetamine to amphetamine/dextroamphetamine ER significantly decreased long-acting amphetamine stimulant medication costs with no difference in [adverse drug events],” the researchers concluded. “Further evaluation of the doses and cost per patient day would be called for to determine if a change from extended-release to immediate-release formulations are associated with equivalent therapeutic outcomes.”


  1. Webb KS, Sun J, Van Cura J, Spencer D. Therapeutic interchange cost-savings initiative: Lisdexamfetamine to amphetamine/dextroamphetamine ER. Presented at: American Society of Health-System Pharmacists 2022 Midyear Clinical Meeting; December 4-8, 2022; Las Vegas, NV. Poster 8-132.
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