The Brazilian policy of withholding treatment for ADHD is probably increasing health and social costs

Maia, Carlos Renato Moreira; Stella, Steffan Frosi; Mattos, Paulo; Polanczyk, Guilherme Vanoni; Polanczyk, Carísi Anne; Rohde, Luís Augusto

doi:10.1590/1516-4446-2014-1378

Cited by 11 publications

(4 citation statements)

References 13 publications

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“…Critics underline the lack of national policies for ADHD treatments and the complexity involved in granting access for procedures for lowincome patients to obtain methylphenidate within SUS (by lawsuits or through an administrative process beset by red tape). Maia et al (2015) estimate that only the direct consequences of not treating children with ADHD ages 5-19 would amount ∼R$ 1,841 billion/year (Brazilian real), and if the country increases its investment in treatments from the current R$ 28 million spent by families out of pocket to R$ 377 million, the amount saved would be 3.1 times higher than the expenses.…”

Section: Production Prescription and Consumption Of Methylphenidate mentioning

confidence: 99%

Global Mental Health and Pharmacology: The Case of Attention Deficit and Hyperactivity Disorders in Brazil

Ortega

Müller

2020

Front. Sociol.

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Global Mental Health (GMH) is the field of study, research, and intervention, which aims at improving access to mental health worldwide. It is based on the global burden of disease research program and on the existence of a large “treatment gap” between the need and availability of mental health services, displaying individual and social costs of undiagnosed and untreated mental disorders, especially in low- and middle-income countries (LMIC). Few academic publications in Brazil dialogue directly with the field of GMH, although several issues drawn from its agenda have been the subject of mental health policies in the country. Brazil can be classified as a middle-income country with a well-structured national health system. This system is oriented toward primary health care, which integrates both community mental health services and the broader health care network. The debate between GMH advocates and critics has unearthed old controversies in psychiatry such as universality or cultural specificity of mental disorders, their expressions, and their relationship with social and economic factors. We intend to examine how these controversies reverberate in the Brazilian mental health scenario, taking as an illustration the debates around Attention Deficit Hyperactivity Disorder (ADHD) in the country. ADHD discussions oppose those who argue that the condition is underdiagnosed and undertreated, and those who claim that there is overdiagnosis and overtreatment and thus, medicalization of childhood. This article presents the current status of the Brazilian mental health literature on ADHD, with emphasis on tensions around diagnosis, prevalence and interventions. Our aim is to highlight how the differential in discourse shapes the debate on ADHD in Brazil and how this may contribute to the GMH agenda. This goal will be undertaken in three steps. First, we will briefly examine studies around GMH and ADHD. Secondly, we address Brazilian studies on this theme, considering the specificities regarding the constitution of the mental health field. Finally, we will examine the debate of treatment gap vs. medicalization in the country in order to underscore the potentials and limitations of each perspective.

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Section: Production Prescription and Consumption Of Methylphenidate mentioning

confidence: 99%

Global Mental Health and Pharmacology: The Case of Attention Deficit and Hyperactivity Disorders in Brazil

Ortega

Müller

2020

Front. Sociol.

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“…13 In Brazil, an extremely conservative analysis, considering an ADHD prevalence of 0.9% (the lowest described in the country), reveals an estimated annual cost of R$ 1.6 billion/year in two main areas: grade repetition and emergency department use. 4 In the same study, the authors predicted annual savings of around R$ 1 billion/year if patients could have access to treatment with MPH-IR 30 mg/day, as suggested by the World Health Organization (WHO). 14 In contrast, economic analyses in the Brazilian mental health system are infrequent; a literature search found only one cost-effectiveness study in the mental health field in the country, on adult schizophrenia.…”

Section: Introductionmentioning

confidence: 95%

“…[1][2][3] Nevertheless, MPH is not an available treatment for many people in low/middleincome countries (LMICs), such as Brazil, where it is estimated that around 257,662 individuals are not receiving ADHD treatment. 4 The decision to provide treatment in the Brazilian public health system lies with healthcare managers. 5 ADHD is characterized by non-episodic inattention and/or a hyperactivity/impulsivity behavior pattern occurring more frequently than expected for the patient's age.…”

Section: Introductionmentioning

confidence: 99%

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

Maia

Stella²,

Wagner

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

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“…Recommended treatments include medication and psychosocial interventions. In Brazil, the most readily available treatment is pharmacotherapy; however, the published research indicates that less than 20% of children with ADHD are prescribed medication for symptom management (Maia et al, 2015). Little information is available regarding access to and use of empirically supported non-pharmacological interventions for ADHD (Ortega & Müller, 2020).…”

Section: Introductionmentioning

confidence: 99%

Needs Assessment for behavioral parent training for ADHD in Brazil

Bado¹,

Costa²,

Bernardes³

et al. 2022

Preprint

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Attention-Deficit / Hyperactivity Disorder (ADHD) is a debilitating condition affecting children and their families worldwide. Behavioral parent training is the only empirically supported non-pharmacological intervention for young children with mild to moderate ADHD. However, access to such treatment is limited in many countries. Here we identify the treatment needs of Brazilian families with children demonstrating symptoms of ADHD, and the barriers families face in accessing behavioral treatment. A qualitative needs assessment was undertaken with parents (n = 23), educators (n = 15), and healthcare providers (n = 16). Semi-structured telephone interviews were conducted, and common themes were identified through inductive coding of participants’ responses. Participants reported a lack of accessible behavioral treatment, together with delays in accessing treatment when available. The majority of parents had not received behavioral parent training, despite it being a recommended form of treatment. Parents, educators and healthcare strongly endorsed a need for practical tools to manage the behavior of children with ADHD. Existing services are not meeting the needs of children with ADHD and their families in Brazil. Easily accessed behavioral parent training programs are recommended to address the identified treatment gap for Brazilian children with ADHD and their families.

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The Brazilian policy of withholding treatment for ADHD is probably increasing health and social costs

Cited by 11 publications

References 13 publications

Global Mental Health and Pharmacology: The Case of Attention Deficit and Hyperactivity Disorders in Brazil

Global Mental Health and Pharmacology: The Case of Attention Deficit and Hyperactivity Disorders in Brazil

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

Needs Assessment for behavioral parent training for ADHD in Brazil

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