Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

[1]  V. Roessner,et al.  Accident Proneness in Children and Adolescents Affected by ADHD and the Impact of Medication , 2016, Journal of attention disorders.

[2]  Richard N Kocsis,et al.  Book Review: Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5) , 2013 .

[3]  J. Zeidler,et al.  Descriptive comparison of drug treatment-persistent, -nonpersistent, and nondrug treatment patients with newly diagnosed attention deficit/hyperactivity disorder in Germany. , 2013, Clinical therapeutics.

[4]  C. Polanczyk,et al.  Economic evaluation in the field of mental health: conceptual basis. , 2013, Revista brasileira de psiquiatria.

[5]  C. Polanczyk,et al.  REVIEW ARTICLE Mental health economics: Insights from Brazil , 2013, Journal of mental health.

[6]  David Moher,et al.  Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement , 2013, International Journal of Technology Assessment in Health Care.

[7]  D. Murphy,et al.  Rates of undiagnosed attention deficit hyperactivity disorder in London drug and alcohol detoxification units , 2012, BMC Psychiatry.

[8]  Peter J Neumann,et al.  Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. , 2012, Journal of the American Academy of Child and Adolescent Psychiatry.

[9]  C. Kieling,et al.  Child and adolescent mental health worldwide: evidence for action , 2011, The Lancet.

[10]  C. G. Lim,et al.  Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment , 2011 .

[11]  E. Michael Foster,et al.  The Estimated Annual Cost of ADHD to the US Education System , 2011, School mental health.

[12]  S. Willich,et al.  Economic analysis based on multinational studies: methods for adapting findings to national contexts , 2010, Journal of Public Health.

[13]  A. Flisher,et al.  Packages of Care for Attention-Deficit Hyperactivity Disorder in Low- and Middle-Income Countries , 2010, PLoS medicine.

[14]  P. Zucchi,et al.  [Judicial demands and therapeutic assistance in the Brazilian Public Health System]. , 2009, Revista da Associacao Medica Brasileira.

[15]  Jason M. Fletcher,et al.  Long-Term Consequences of Childhood ADHD on Criminal Activities , 2009, The journal of mental health policy and economics.

[16]  L. Lindner,et al.  Economic evaluation of antipsychotic drugs for schizophrenia treatment within the Brazilian Healthcare System. , 2009, Revista de saude publica.

[17]  T. Dilla,et al.  A modelled economic evaluation comparing atomoxetine with methylphenidate in the treatment of children with attention-deficit/hyperactivity disorder in Spain , 2009, BMC psychiatry.

[18]  J. Horsman,et al.  Disability and Health-related Quality of Life in Long-term Survivors of Cancer in Childhood in Brazil , 2008, Journal of pediatric hematology/oncology.

[19]  S. Pliszka,et al.  Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[20]  M. Drummond,et al.  A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents. , 2006, Health technology assessment.

[21]  J. Swanson,et al.  Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD. , 2005, The American journal of psychiatry.

[22]  J. Horsman,et al.  Translation and cultural adaptation of Health Utilities Index (HUI) Mark 2 (HUI2) and Mark 3 (HUI3) with application to survivors of childhood cancer in Brazil , 2005, Quality of Life Research.

[23]  J. Hay,et al.  Cost effectiveness of methylphenidate versus AMP/DEX mixed salts for the first-line treatment of ADHD , 2004, Expert review of pharmacoeconomics & outcomes research.

[24]  T. Vos,et al.  Cost-effectiveness of dexamphetamine and methylphenidate for the treatment of childhood attention deficit hyperactivity disorder. , 2004, The Australian and New Zealand journal of psychiatry.

[25]  M. Prince,et al.  Resource utilisation for neuropsychiatric disorders in developing countries: , 2004, Social Psychiatry and Psychiatric Epidemiology.

[26]  D. Feeny,et al.  The Health Utilities Index (HUI®): concepts, measurement properties and applications , 2003, Health and quality of life outcomes.

[27]  S. Petrou.  Methodological issues raised by preference-based approaches to measuring the health status of children. , 2003, Health economics.

[28]  Eugenia Chan,et al.  Health care use and costs for children with attention-deficit/hyperactivity disorder: national estimates from the medical expenditure panel survey. , 2002, Archives of pediatrics & adolescent medicine.

[29]  M. Boyle,et al.  Multiattribute and Single‐Attribute Utility Functions for the Health Utilities Index Mark 3 System , 2002, Medical care.

[30]  D. Thiruchelvam,et al.  Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[31]  R. Milne,et al.  Methylphenidate in children with hyperactivity: review and cost–utility analysis , 2001, Pharmacoepidemiology and drug safety.

[32]  Elizabeth B. Owens,et al.  Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[33]  N. Ryan,et al.  Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[34]  M. Weinstein,et al.  The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. , 1996, JAMA.

[35]  R. Barkley,et al.  Side effects of methylphenidate in children with attention deficit hyperactivity disorder: a systemic, placebo-controlled evaluation. , 1990, Pediatrics.

[36]  E J Costello,et al.  Validity of the NIMH Diagnostic Interview Schedule for Children: A comparison between psychiatric and pediatric referrals , 1985, Journal of abnormal child psychology.

[37]  L. Rohde,et al.  The Brazilian policy of withholding treatment for ADHD is probably increasing health and social costs. , 2015, Revista brasileira de psiquiatria.

[38]  M. Bullinger,et al.  Generic Health-Related Quality-of-Life Assessment in Children and Adolescents , 2012, PharmacoEconomics.

[39]  J. Stockman.  Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among U.S. children: results from a nationally representative study , 2010 .

[40]  J. Buitelaar,et al.  European clinical guidelines for hyperkinetic disorder – first upgrade , 2004, European Child & Adolescent Psychiatry.

[41]  J. Buitelaar,et al.  European clinical guidelines for hyperkinetic disorder , 2004 .

[42]  J. Swanson.  Compliance with Stimulants for Attention-Deficit/Hyperactivity Disorder , 2003, CNS drugs.

[43]  A. Ralston.  Side effect , 2003 .

[44]  H. Gerhard,et al.  [Side effects]. , 1955, Hippokrates.