Estimation of Utilities in Attention-Deficit Hyperactivity Disorder for Economic Evaluations

Lloyd, Andrew; Hodgkins, Paul; Sasané, Rahul; Akehurst, Ron; Sonuga‐Barke, Edmund; Fitzgerald, Patrick; Nixon, Annabel; Erder, Haim; Brazier, John

doi:10.2165/11592150-000000000-00000

Cited by 18 publications

(23 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionsupporting

confidence: 87%

“…Utility values identified in the current study were in a similar range to TTO utilities previously reported by Lloyd et al7 for childhood ADHD. The current utility of 0.82 for a health state representing treatment responders who have symptoms “once in a while” with “minimal consequences” is between the values Lloyd et al reported for childhood ADHD with severity levels of “normal” (0.84) and “borderline to mildly ill” (0.79) 7. The current scores of 0.68 and 0.67 for health states describing nonresponders and untreated patients, respectively, are between the previously reported values for childhood ADHD with severity levels of “borderline to mildly ill” (0.79) and “moderately to markedly ill” (0.58).…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Health state utilities associated with adult attention-deficit/hyperactivity disorder

Matza¹,

Devine²,

Haynes³

et al. 2014

PPA

View full text Add to dashboard Cite

ObjectivesWith growing awareness of the importance of adult attention-deficit/hyperactivity disorder (ADHD) treatment, cost-effectiveness analyses, including utilities, are needed to compare the value of treatment options. Although utilities have been reported for childhood ADHD, little is known about utilities representing adult ADHD. Therefore, the purpose of this study was to estimate utilities associated with adult ADHD.MethodsHealth-state descriptions of adult ADHD were drafted based on literature review, interviews with four clinicians, and clinical trial data. Health states were revised based on a pilot study with 26 participants. Final health states were rated in time trade-off interviews with general population respondents in London and Edinburgh, UK.ResultsA total of 158 participants completed interviews (mean age =47.0 years; 49.4% female; Edinburgh =80 participants). Mean (standard deviation [SD]) utilities were 0.82 (0.17), 0.68 (0.28), and 0.67 (0.28) for health states describing treatment responders (health state A), nonresponders (health state B), and untreated patients (health state C), respectively. Most participants rated health state A as preferable to B (n=92; 58.2%) and C (n=97; 61.4%). The majority rated B and C as equal (n=125; 79.1%). Paired Student’s t-tests found that A had a significantly greater mean utility than B (t=10.0; P<0.0001) and C (t=10.2; P<0.0001).ConclusionThe current study provides utilities that may be used in cost–utility models of treatment for adult ADHD. Results reflected clear differences between health states representing treatment responders and nonresponders/untreated patients. Current utilities were comparable to those previously reported for childhood ADHD.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Health state utilities associated with adult attention-deficit/hyperactivity disorder

Matza¹,

Devine²,

Haynes³

et al. 2014

PPA

View full text Add to dashboard Cite

show abstract

“…[22,25] Because the four health states have not been defined in the literature based on the ADHD-RS-IV scale, the CGI-S was used in this study in order to be consistent with the definition of health states used in the study from which ADHD health utility values were extracted. [26]…”

Section: Methodsmentioning

confidence: 99%

“…Utility values were obtained from a recent study by Lloyd et al[26] In our model, health states based on the CGI-S were defined in the same way as those from Lloyd et al, with the exception that the severe state in their study excluded the most severe CGI-S state 7, ‘among the most extremely ill subjects’. The utility data were collected from a survey of 100 members of the general public in the UK.…”

Section: Methodsmentioning

confidence: 99%

Cost Effectiveness of Guanfacine Extended Release as an Adjunctive Therapy to a Stimulant Compared with Stimulant Monotherapy for the Treatment of Attention-Deficit Hyperactivity Disorder in Children and Adolescents

et al. 2012

Self Cite

View full text Add to dashboard Cite

BackgroundAttention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in childhood, affecting 3–7% of school-age children in the US and imposing substantial economic burden. Stimulants are considered first-line pharmacological treatment and are the most prescribed treatment for ADHD. However, approximately 30% of children with ADHD do not have an optimal response to a single stimulant and may require adjunctive therapy.ObjectiveOur objective was to conduct a cost-effectiveness analysis (CEA) of adding a non-stimulant, guanfacine extended release (GXR), to stimulants versus maintaining existing stimulant monotherapy in the treatment of ADHD in children and adolescents with suboptimal response to stimulant monotherapy.MethodsA 1-year Markov model was developed to estimate costs and effectiveness from a US third-party payer perspective. Effectiveness was measured by the QALY. The model assumed that patients transitioned among four health states (normal, mild, moderate and severe), defined by the Clinical Global Impression-Severity (CGI-S) scale. Transition probabilities were estimated in an ordered logit model using patient-level data from a multicentre, 9-week, double-blind, placebo-controlled, dose-optimization study, where subjects (n=461) continued their stable morning stimulant and were randomized to GXR administered in the morning, GXR administered in the evening, or placebo. The model assumed that patients in moderate/severe health states after week 8 would discontinue ADHD treatment and remain in that state for the rest of the study period. Direct costs included drug wholesale acquisition costs and health state costs, all in $US, year 2010 values. Utility associated with each health state was obtained from the literature and disutilities associated with adverse events were applied for the first 4 weeks. Oneway sensitivity analyses and probabilistic sensitivity analysis (PSA) were conducted by varying costs, utilities, adverse-event duration, and transition probabilities.ResultsCompared with maintaining existing stimulant monotherapy, adding GXR to existing stimulant monotherapy was associated with an incremental drug cost of $US1016 but a lower medical cost of $US124, resulting in a total incremental cost of $US892 at 1 year. The addition of GXR to stimulants led to an incremental QALY of 0.03 and an incremental cost-effectiveness ratio (ICER) of $US31 660/QALY. In one-way sensitivity analysis, ICER values ranged from $US19 723, when 100% of patients were assumed to be severe in their initial health state, to $US46631, when the last observed states from the clinical trial were carried forward to the end of the 1-year analysis period. PSA demonstrated a 94.6% likelihood that the ICER falls below $US50 000/QALY.ConclusionsThe impairment associated with residual ADHD symptoms after stimulant therapy is becoming increasingly recognized. This is the first analysis of the cost effectiveness of stimulants combined with an adjunctive medication. This study suggests that the adjunctive therapy of...

show abstract

“…A study from Lloyd et al [82] developed a classification system of four health states (normal; borderline to mildly ill; moderately to markedly ill and severely ill), reflecting different levels of severity of the patient’s symptoms. A similar approach will be explored, classifying children by severity using the primary outcome and the EQ-5D, depending on the variation in severity of those recruited.…”

Section: Informed Consentmentioning

confidence: 99%

Study protocol for a randomized controlled trial comparing the efficacy of a specialist and a generic parenting programme for the treatment of preschool ADHD

McCann

Thompson

Daley

et al. 2014

Trials

View full text Add to dashboard Cite

BackgroundThe New Forest Parenting Programme (NFPP) is a home-delivered, evidence-based parenting programme to target symptoms of attention-deficit/hyperactivity disorder (ADHD) in preschool children. It has been adapted for use with ‘hard-to-reach’ or ‘difficult-to-treat’ children. This trial will compare the adapted-NFPP with a generic parenting group-based programme, Incredible Years (IY), which has been recommended for children with preschool-type ADHD symptoms.Methods/designThis multicentre randomized controlled trial comprises three arms: adapted-NFPP, IY and treatment as usual (TAU). A sample of 329 parents of preschool-aged children with a research diagnosis of ADHD enriched for hard-to-reach and potentially treatment-resistant children will be allocated to the arms in the ratio 3:3:1. Participants in the adapted-NFPP and IY arms receive an induction visit followed by 12 weekly parenting sessions of 1½ hours (adapted-NFPP) or 2½ hours (IY) over 2.5 years. Adapted-NFPP will be delivered as a one-to-one home-based intervention; IY, as a group-based intervention. TAU participants are offered a parenting programme at the end of the study. The primary objective is to test whether the adapted-NFPP produces beneficial effects in terms of core ADHD symptoms. Secondary objectives include examination of the treatment impact on secondary outcomes, a study of cost-effectiveness and examination of the mediating role of treatment-induced changes in parenting behaviour and neuropsychological function. The primary outcome is change in ADHD symptoms, as measured by the parent-completed version of the SNAP-IV questionnaire, adjusted for pretreatment SNAP-IV score. Secondary outcome measures are: a validated index of behaviour during child’s solo play; teacher-reported SNAP-IV (ADHD scale); teacher and parent SNAP-IV (ODD) Scale; Eyberg Child Behaviour Inventory - Oppositional Defiant Disorder scale; Revised Client Service Receipt Inventory - Health Economics Costs measure and EuroQol (EQ5D) health-related quality-of-life measure. Follow-up measures will be collected 6 months after treatment for participants allocated to adapted-NFPP and IY.DiscussionThis trial will provide evidence as to whether the adapted-NFPP is more effective and cost-effective than the recommended treatment and TAU. It will also provide information about mediating factors (improved parenting and neuropsychological function) and moderating factors (parent and child genetic factors) in any increased benefit.Trial registrationCurrent Controlled Trials, ISRCTN39288126.

show abstract

Estimation of Utilities in Attention-Deficit Hyperactivity Disorder for Economic Evaluations

Cited by 18 publications

References 27 publications

Health state utilities associated with adult attention-deficit/hyperactivity disorder

Health state utilities associated with adult attention-deficit/hyperactivity disorder

Cost Effectiveness of Guanfacine Extended Release as an Adjunctive Therapy to a Stimulant Compared with Stimulant Monotherapy for the Treatment of Attention-Deficit Hyperactivity Disorder in Children and Adolescents

Study protocol for a randomized controlled trial comparing the efficacy of a specialist and a generic parenting programme for the treatment of preschool ADHD

Contact Info

Product

Resources

About