Off-Label Utilization of Antihypertensive Medications in Children

To examine off-label use and costs of antihypertensive drugs in children by using a national sample of prescription claims.We conducted a cross-sectional study using the 2002 Medstat MarketScan Database, a national sample of outpatient prescription claims of childrenor=18 years old enrolled in private, employer-sponsored health plans. Our main outcomes were off-label use of antihypertensive drugs by patient age and costs of antihypertensives calculated as mean cost per child per 30-day fill.One half of the index antihypertensive prescription claims were off label, based on minimum age criteria. Boys were more likely (56%) than girls (46%) to be prescribed off-label antihypertensives (P.001). Children agedor=12 years were more likely to be prescribed off-label antihypertensives (53%) compared with children agedor=5 (46%) and 6-11 years (42%; P.001). Off-label use varied significantly by class of antihypertensive drugs (P.001). Overall, off-label antihypertensives were significantly more expensive than on-label antihypertensives.Despite availability of often less expensive on-label alternatives for the same class of antihypertensive drugs, off-label antihypertensive drugs were prescribed frequently in children. These findings underscore the potential clinical and economic implications of common off-label prescribing, for children, their parents, physicians, and payers.