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Cited by 58Attention Deficit Hyperactivity DisorderHealth Systems, Economic Evaluations, Quality of LifePharmaceutical studies and practices

Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder: A Systematic Literature Review

Wu, Eric Q., Hodgkins, Paul, Ben-Hamadi, Rym, Setyawan, Juliana, Xie, Jipan, Sikirica, Vanja, Du, Ella X., Yan, Sherry Y. +1 more·2012·CNS Drugs
DOI 10.2165/11633900-000000000-00000
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Abstract

Background Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder that impairs the quality of life for patients and their families and is associated with considerable direct and indirect costs. Pharmacotherapies for ADHD, including stimulants and non-stimulants, are often used to treat patients with ADHD. However, the costs, effectiveness and adverse effects of these agents vary. Therefore, information regarding the cost effectiveness of different pharmacological treatments is needed to better inform payers in the allocation of limited resources. Objectives The objectives of this study were to conduct a systematic literature review of economic evaluations of pharmacotherapies for ADHD treatments and to assess the cost effectiveness of different interventions based on the existing studies. Methods A systematic literature review of economic evaluations of pharmacotherapies for ADHD was conducted in MEDLINE, the National Health Services (NHS) Economic Evaluation database and EMBASE. For inclusion in this review, studies had to compare two or more ADHD interventions with at least one pharmacotherapy, assess both costs and outcomes, and be conducted between 1990 and 2011 in North America, Europe, Australia or New Zealand. Studies were excluded if they were not original research, were presented only as conference proceedings or abstracts or did not report costs associated with specific interventions. The study quality was assessed using the British Medical Journal (BMJ) health economics checklist. The literature search, data extraction and quality assessment were performed by one author and independently checked for accuracy by a second author. Discrepancies were resolved by consensus and referring to the original article. If necessary, a third reviewer was consulted. Results The initial search returned 93 citations from MEDLINE, 10 from the NHS Economic Evaluation database and 377 from EMBASE. Thirteen papers met the inclusion/exclusion criteria and were included in the review. Based on the BMJ checklist, all these studies were considered to be of sufficient quality to be included in the literature review, but they varied substantially in target population, methodology and effectiveness measures. Identified pharmacotherapies were cost effective compared with no treatment, placebo, behavioural therapy or community care among children and adolescents with ADHD. Studies comparing non-stimulants with stimulants and amfetamine with methylphenidate stimulants showed inconsistent findings. A limited number of studies indicated that methylphenidate Osmotic-controlled Release Oral delivery System (OROS) was cost effective compared with short-acting methylphenidate. There were no published studies on the cost effectiveness of pharmacotherapy in the adult ADHD population, comparing stimulants, non-stimulants or adjuvant therapy. There is limited evidence on the long-term cost effectiveness of pharmacotherapies. Conclusions Among children and adolescents with ADHD, there was consistent evidence that pharmacotherapies are cost effective compared with no treatment or behavioural therapy. Adequate data are lacking to draw conclusions regarding the relative cost effectiveness of different pharmacological agents. More economic evaluations with standardized methods, such as effectiveness measures and cost components, are warranted. To better inform payers about the economic value of existing medications, future studies should also consider identifying subgroups that may have heterogeneous responses to different treatments, including analyses of recently approved treatments (e.g. lisdexamfetamine, guanfacine extended-release and clonidine extended-release) and expanding the time horizon to incorporate long-term outcomes.

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Crossref · 10.2165/11633900-000000000-00000

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  • Pharmacotherapy for ADHD is efficacious and cost-effective compared with behavioral therapy alone and compared with combined use of behavioral and pharmacotherapy.

    “Pharmacotherapy for ADHD is an efficacious as well as cost-effective treatment measure for ADHD when compared with behavioral therapy alone and compared with combined use of behavioral and pharmacotherapy.45”

    From Update on optimal use of lisdexamfetamine in the treatment of ADHD (2013) · cites this paper as [45]

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Authors
Wu, E. Q., Hodgkins, P., Ben-Hamadi, R., Setyawan, J., Xie, J., Sikirica, V., Du, E. X., Yan, S. Y., & Erder, M. H.
Affiliations
Analysis Group (United States) (US)
Corresponding author
Wu, Eric Q.
ORCID
Venue
CNS Drugs
Publisher
Springer Science and Business Media LLC
Published
2012-07
Volume
26
Issue
7
Pages
581-600
ISSN
1172-7047 (ISSN-L)
DOI
10.2165/11633900-000000000-00000
OpenAlex
W2237809588
Cited by
58
References
68
Citations by year
2025: 2 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 5 · 2020: 5 · 2019: 2 · 2018: 5 · 2017: 4 · 2016: 7 · 2015: 7 · 2014: 5 · 2013: 5 · 2012: 1
FWCI
0.78
Type
journal article
Language
en
Open access
closed
Locations
  • CNS Drugs (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
Keywords
attention deficit hyperactivity disorder, pharmacotherapy, cost-effectiveness, stimulants, methylphenidate, amphetamine, OROS methylphenidate, economic evaluation, children and adolescents, behavior therapy, resource allocation, health care costs, adverse effects, quality of life, adult ADHD, health technology assessment
MeSH terms
Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Australia, Cost-Benefit Analysis, Europe, Humans, New Zealand, North America, Treatment Outcome

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