Probabilistic Markov Model Estimating Cost Effectiveness of Methylphenidate Osmotic-Release Oral System Versus Immediate-Release Methylphenidate in Children and Adolescents: Which Information is Needed?

Abstract

BackgroundIncidence of attention deficit hyperactivity disorder (ADHD) in children and adolescents has been increasing. The disorder results in high societal costs. Policymakers increasingly use health economic evaluations to inform decisions on competing treatments of ADHD. Yet, health economic evaluations of first-choice medication of ADHD in children and adolescents are scarce and generally do not include broader societal effects.ObjectivesThis study presents a probabilistic model and analysis of methylphenidate osmotic-release oral system (OROS) versus methylphenidate immediate-release (IR). We investigate and include relevant societal aspects in the analysis so as to provide cost-effectiveness estimates based on a broad societal perspective.MethodsWe enhanced an existing Markov model and determined the cost effectiveness of OROS versus IR for children and adolescents responding suboptimally to treatment with IR. Enhancements included screening of a broad literature base, updated utility values, inclusion of costs and effects on caregivers and a change of the model type from deterministic to probabilistic.ResultsThe base case scenario resulted in lower incremental costs (€−5815) of OROS compared with IR and higher incremental quality-adjusted life-year (QALY) gains (0.22). Scenario analyses were performed to determine sensitivity to changes in transition rates, utility of caregivers, medical costs of caregivers and daily medication dose.ConclusionsThe results indicate that, for children responding suboptimally to treatment with IR, the beneficial effect of OROS on compliance may be worth the additional costs of medication. The presented model adds to the health economic information available for policymakers and to considerations on a broader perspective in cost-effectiveness analyses.

The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review

“…Most studies targeting ADHD were of good quality (n = 8) [32][33][34][35][36][37][38][39], and two studies were of moderate quality [40,41]. Both studies targeting ASD were of good quality [42,43].…”

Incorporating Household Spillovers in Cost Utility Analysis: A Case Study Using Behavior Change in COPD

“…Beyond behavioural interventions, only a handful of published trials have contemporaneously measured the spillover on family members' health status and hence quality adjusted life years (QALYs) for inclusion in an economic evaluation (18)(19)(20). Due to this absence of trial data on spillovers, some economic evaluations have used spillover estimates obtained from external studies related to a different health condition; for example an economic evaluation of a long-acting formulation of methylphenidate for ADHD used an estimate of spillover of meningitis (21) and an economic evaluation of Tysabri for multiple sclerosis used an estimate of spillover of Alzheimer's disease (22).…”

“…An important methodological uncertainty relates to how many family/social network members should be included in an economic evaluation. Most economic evaluations including spillover consider one family member per patient (23), although we are aware of two studies which included spillover for four family members per patient (21;24). More generally it has been proposed that a function could be fitted to estimate the multiplier effect of a health spillover through the whole family network (1).…”

Cost-Effectiveness of Treatments in Children With Attention-Deficit/Hyperactivity Disorder: A Continuous-Time Markov Modeling Approach

“…Contrary to previous Markov models for ADHD treatment evaluation, 13–16 we propose a different model structure. First, ADHD is a chronic condition that makes a full remission state unlikely.…”

“…Finally, the previous Markov models for ADHD treatment evaluation consider discrete time periods. 13–16 Consequently, changes in states occur only at the beginning or end of predefined time intervals. 26 We have relaxed this assumption to build our model in continuous time.…”