Cost-Effectiveness of ADHD Treatments: Findings From the Multimodal Treatment Study of Children With ADHD

Abstract

Objective: Attention deficit hyperactivity disorder (ADHD) is a costly public health problem. To the authors' knowledge, this is the first study on the cost-effectiveness of the major forms of ADHD treatments used in NIMH's Multimodal Treatment Study of Children With ADHD (MTA Study).Method: Five hundred seventy-nine children with ADHD, combined type, ages 7 to 9.9, were assigned to 14 months of medication management, behavioral treatment, both combined, or community care. Services were tallied throughout the study, including medication, health care visits, behavioral treatments, and rental costs. Provider specialty, total time, and number of visits with providers were used to calculate costs, adjusted to FY 2000 dollars with the consumer price index.Results: Treatment costs varied fourfold, with medication management being the least expensive, followed by behavioral treatment, and then combined treatment. Lower costs of medication treatment were found in the community care group, reflecting the less intensive (and less effective) nature of community-delivered treatment. Medical management was more effective but more costly than community care and more cost-effective than combination treatment and behavioral treatment alone. Under some conditions, combination treatment (medical management and psychotherapy) were somewhat more cost-effective, as demonstrated by lower costs per additional child "normalized" among children with multiple comorbid disorders.Conclusions: Medical management treatment, although not as effective as combined medical management and behavioral treatment, is likely to be more cost-effective in routine treatment for children with ADHD, particularly those without comorbid disorders. For some children with comorbid disorders, it may be cost-effective to provide combination treatment.

Comparative Treatment Patterns, Resource Utilization, and Costs in Stimulant-Treated Children with ADHD Who Require Subsequent Pharmacotherapy with Atypical Antipsychotics Versus Non-Antipsychotics

“…[5][6][7][8][9][10][11] Treatment options for ADHD include medication management, behavioral treatment, or combination of the two, with medication management being the most cost-effective. 12 Stimulants are an effective first-line treatment option for the majority of ADHD patients, with about 70% of patients responding to treatment in the short term (within 6-10 weeks). 13,14 However, a subset of the patient population treated with stimulants will seek an alternative medication regimen for a variety of reasons, such as lack of improvement, tolerability issues, or the possible negative societal perception of stimulants.…”

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

“…41 The main reasons for our choice of MPH-IR could be summarized as: the high costs of extended-release presentations, the absence of a specific policy for ADHD treatment by the Brazilian authorities, 45 and the high costs of adding combined treatments, as demonstrated by the MTA. 17 Lastly, the MPH-IR prices adopted are exclusively for the Brazilian government, which means they are lower than wholesale prices. To test the difference, an additional analysis for the base case with the highest price on the Brazilian market at the time of writing (I$ 0.56/pill, which represents I$ 50.4/month) was conducted.…”

“…In contrast, countries like the UK, 16 the U.S., 17 Australia, 18 and Spain 19 are largely focusing on economic analysis and health policy for ADHD treatment. To date, a systematic review found 14 studies from different countries on the theme.…”

Pharmacotherapeutic options for attention deficit hyperactivity disorder (ADHD)

“…Drug treatment, though not as effective as in combination with behavioral treatment, is likely to be more cost effective in treatment of children with ADHD, especially those without co-morbid disorders. 7 Amphetamines have been in use in the treatment of ADHD since last 50 years; and other drugs such as tricyclic antidepressants (imipramine and desipramine), bupropion, pemoline, 3 rd generation antidepressant venlafaxine, selegiline and alpha-2 agonists (clonidine and gaunfacine) also have been tried. 8 Commonly used drugs for treating ADHD in children are stimulants (methylphenidate, amphetamine and methamphetamine), bupropion and atomoxetine (Table 1).…”

“…7 These agents are last-step alternatives in the management of ADHD. TCAs (imipramine, desipramine, nortriptyline)…”