Pharmacotherapy and child psychiatry: is there a way
                        forward?

James, Anthony

doi:10.1192/apt.bp.107.003830

Cited by 2 publications

(1 citation statement)

References 40 publications

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“…(4) Given the wide variety of measurement instruments [63,64], can a sufficient degree of harmonization of study designs and effectiveness endpoints be achieved? This observation should prompt some healthy skepticism among the recipients of such studies [238][239][240]. (5) Future studies should include index-instruments enabling the transformation of health-related quality of life in utility weights for QALY calculation.…”

Section: Some Implicationsmentioning

confidence: 99%

The Pharmaceutical Economics of Child Psychiatric Drug Treatment

Schlander¹

2010

CPD

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The last decade, the number of health economic evaluations has increased substantially in the field of child psychiatry. The objective of the present paper is to offer an overview of economic evaluations of child psychiatric drug treatment. Major electronic databases, as well as abstract booklets from international clinical and health economics conferences with an external peer review process, were examined to search for comparative economic evaluations of child and adolescent psychiatric drug treatment. Most studies of pharmacotreatment were cost effectiveness analyses (CEAs) concerned with attention-deficit/hyperactivity disorder (ADHD). Three evaluations were done by or on behalf of agencies as part of ADHD-related health technology assessments. A number of economic studies used patient-level data from specific randomized clinical trials, especially the NIMH-initiated MTA (in childhood ADHD) and TADS (in adolescent major depression) studies. Almost all studies relied on narrow scale symptom scales to assess effects of treatment, even when quality-adjusted life years (QALYs) were reported. In many cases, effectiveness data came from short-term studies, and extrapolation to a one-year time horizon was usually based on assumptions. Even those evaluations attempting to address longer time horizons by way of modeling did not include the impact of treatment on long-term sequelae of the conditions studied, mainly due to a paucity of robust clinical data. Nevertheless, currently available health economic evaluations broadly suggest an acceptable to attractive cost effectiveness of medication management of ADHD, whereas there is no such evidence for child psychiatric disorders other than ADHD.

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Section: Some Implicationsmentioning

confidence: 99%

The Pharmaceutical Economics of Child Psychiatric Drug Treatment

Schlander¹

2010

CPD

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Off-label psychotropic prescribing for young persons in medium security

Haw

Stubbs

2009

J Psychopharmacol

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Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed.

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Pharmacotherapy and child psychiatry: is there a way forward?

Cited by 2 publications

References 40 publications

The Pharmaceutical Economics of Child Psychiatric Drug Treatment

The Pharmaceutical Economics of Child Psychiatric Drug Treatment

Off-label psychotropic prescribing for young persons in medium security

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