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

Abstract

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.

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].…”

“…Among the good-quality studies, seven were modeling exercises [33][34][35][36][37][38][39] and simulated the costs and benefits of pharmacotherapies over different time horizons. Four of these studies had a time horizon of 1 year [33,34,36,39], and three had time horizons between 6 and 12 years [35,37,38]. One study was an RCT with a time horizon of 6 months [32].…”

A mixed methods study of clinician reported challenges in the assessment of ADHD and treatment decisions for children with ADHD in Brazil

“…The Brazilian public health agency ‘ANVISA’ strictly controls the prescribing of methylphenidate (Ortega et al, 2018), and a recent act in São Paulo (São Paulo Municipal Ministry of Health, 2014), for example, introduced more bureaucratic procedures for the prescription of psychostimulant medication for children with ADHD. Although there is evidence of the cost-effectiveness of the treatment of ADHD with methylphenidate immediate-release (MPH-IR) in the Brazilian public health system (Maia et al, 2016), the cost and access to therapies are barriers for managing ADHD in Brazil.…”

“…The Brazilian public health agency 'ANVISA' strictly controls the prescribing of methylphenidate (Ortega et al, 2018), and a recent act in São Paulo (São Paulo Municipal Ministry of Health, 2014), for example, introduced more bureaucratic procedures for the prescription of psychostimulant medication for children with ADHD. Although there is evidence of the cost-effectiveness of the treatment of ADHD with methylphenidate immediate-release (MPH-IR) in the Brazilian public health system (Maia et al, 2016), the cost and access to therapies are barriers for managing ADHD in Brazil. Some of the challenges in clinical decision-making were related to the inequalities and lack of access and shared care between specialised psychiatric services and primary care, although surveyed clinicians individually attempt to solve poor communication among and between doctors, allied health professionals and school personnel, as reported in the survey.…”

Generic preference‐based health‐related quality of life in children with neurodevelopmental disorders: a scoping review

“…They were also reported for six broad NDD categories: neurodevelopmental impairments (n=4), neurodevelopmental disability (n=3), specific language impairment (n=2), speech disorder (n=2), learning disability (n=2), and language and speech disorder (n=1) ( Table SIV, Eleven of the 26 studies applied preference weights from countries different to the country of the study population. 54,57,66,68,71,72,74,76,80,85,88 Five studies raised concerns about using preference weights derived from adults to value health state descriptions of children with NDD. 57,59,72,78,81…”