A Modeled Economic Evaluation Comparing Atomoxetine with Stimulant Therapy in the Treatment of Children with Attention-Deficit/Hyperactivity Disorder in the United Kingdom

Cottrell, Suzi; Tilden, Dominic; Robinson, Paul; Bae, Jay; Arellano, Jorge; Edgell, E.T.; Aristides, M; Boye, Kristina S.

doi:10.1111/j.1524-4733.2007.00256.x

Cited by 28 publications

(55 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A further review of these 45 published full-text reports excluded 32 conference submissions, abstracts or review articles and 13 full-text studies were included in the final review (figure 1). [53][54][55][56][57][58][59][60][61][62][63][64][65] To facilitate comparisons across studies, costs were reported in the original currency as well as in 2010 US dollars. Costs in non-US currencies were first converted to US dollars in the same year based on the annual exchange rate in that year.…”

Section: Methodsmentioning

confidence: 99%

Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder

Hodgkins

Ben-Hamadi

et al. 2012

CNS Drugs

View full text Add to dashboard Cite

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.

show abstract

Section: Methodsmentioning

confidence: 99%

Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder

Hodgkins

Ben-Hamadi

et al. 2012

CNS Drugs

View full text Add to dashboard Cite

show abstract

“…In contrast, systemic administration of a selective 5-HT2A receptor antagonist (M100907) had opposite actions, remediating impulsivity in both sham-operated and 5-HT-depleted rats. These contrasting influences of the 5-HT2A and 5-HT2C receptor antagonists were mimicked by infusions of the drugs into the nucleus accumbens, but not the mPFC, in intact animals (Cottrell et al, 2008). However, in variations of the 5-CSRTT, it was possible to detect significant reductions in impulsivity after intra-mPFC infusion of the 5-HT2A receptor antagonist.…”

Section: Pharmacological Differentiation Of Impulsivity and Compulsivmentioning

confidence: 96%

“…Data indicate that impulsivity may derive from one or more distinct neurocognitive mechanisms. These include a tendency to pre-potent motor disinhibition, measured by the stop signal reaction time (SSRT) task (Aron and Poldrack, 2005), mediated in human beings through activation of right inferior frontal (RIF) cortex and its subcortical connections (Rubia et al, 2003) and modulated in rats and human beings by norepinephrine (Chamberlain et al, 2006cCottrell et al, 2008), but not serotonin Chamberlain et al, 2006d). Another aspect involves difficulty in delaying gratification and choosing immediate small rewards despite negative long-term consequences, measured by decision making or gambling tasks such as the Cambridge Gambling Task (CANTAB), mediated through orbitofrontal and related cortical circuitry under probable serotonergic modulation (Rogers et al, 1999b), and subcortical circuitry under joint dopaminergic and serotonergic control (Winstanley et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Probing Compulsive and Impulsive Behaviors, from Animal Models to Endophenotypes: A Narrative Review

Fineberg

Potenza

Chamberlain

et al. 2009

Neuropsychopharmacol

590

468

View full text Add to dashboard Cite

Failures in cortical control of fronto-striatal neural circuits may underpin impulsive and compulsive acts. In this narrative review, we explore these behaviors from the perspective of neural processes and consider how these behaviors and neural processes contribute to mental disorders such as obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder, and impulse-control disorders such as trichotillomania and pathological gambling. We present findings from a broad range of data, comprising translational and human endophenotypes research and clinical treatment trials, focussing on the parallel, functionally segregated, cortico-striatal neural projections, from orbitofrontal cortex (OFC) to medial striatum (caudate nucleus), proposed to drive compulsive activity, and from the anterior cingulate/ventromedial prefrontal cortex to the ventral striatum (nucleus accumbens shell), proposed to drive impulsive activity, and the interaction between them. We suggest that impulsivity and compulsivity each seem to be multidimensional. Impulsive or compulsive behaviors are mediated by overlapping as well as distinct neural substrates. Trichotillomania may stand apart as a disorder of motor-impulse control, whereas pathological gambling involves abnormal ventral reward circuitry that identifies it more closely with substance addiction. OCD shows motor impulsivity and compulsivity, probably mediated through disruption of OFC-caudate circuitry, as well as other frontal, cingulate, and parietal connections. Serotonin and dopamine interact across these circuits to modulate aspects of both impulsive and compulsive responding and as yet unidentified brain-based systems may also have important functions. Targeted application of neurocognitive tasks, receptor-specific neurochemical probes, and brain systems neuroimaging techniques have potential for future research in this field.

show abstract

“…We used utilities assessed from parents of ADHD children using standard gamble methods. 20 Values and associated ranges are listed in Table 1. Because the 95% confidence intervals around the published values for different utility states overlap, we required that the utility of successful medication without side effects be higher than medication with side effects, which in turn was higher than the utility of untreated ADHD.…”

Section: Markov Transition Modelmentioning

confidence: 99%

“…19 Of children who respond to medication, some would experience persistent adverse effects such as insomnia, and the remainder would have benefits without adverse effects. 20 The model accounts for the natural process of remission of ADHD from 7 to 25 years of age 21,22 and for medication discontinuation for other reasons. 23 …”

Section: Adhd Treatmentmentioning

confidence: 99%

Modeled Economic Evaluation of Alternative Strategies to Reduce Sudden Cardiac Death Among Children Treated for Attention Deficit/Hyperactivity Disorder

et al. 2010

View full text Add to dashboard Cite

Background-Stimulants are widely used to treat children with attention deficit/hyperactivity disorder and may increase the risk for sudden cardiac death (SCD). We examined the cost-effectiveness of pretreatment screening with ECG for reducing SCD risk in children diagnosed with attention deficit/hyperactivity disorder who are candidates for stimulant medication. Method and Results-We constructed a state-transition Markov model with 10 annual cycles spanning 7 to 17 years of age. Taking a societal perspective, we compared the cost-effectiveness of 3 screening strategies: (1) performing a history and physical examination with cardiology referral if abnormal (current standard of care); (2) performing a history and physical examination plus ECG after negative history and physical examination, with cardiology referral if either is abnormal; and (3) performing a history and physical examination plus ECG, with cardiology referral only if ECG is abnormal. Children identified with SCD-associated cardiac abnormalities would be restricted from stimulants and from playing competitive sports. The expected incremental cost-effectiveness over strategy 1 was $39 300 and $27 200 per quality-adjusted life-year for strategies 2 and 3, respectively. Monte Carlo simulation found that the chance of incremental cost-effectiveness was 55% for strategy 2 and 71% for strategy 3 (willingness to pay Յ$50 000 per quality-adjusted life-year). Both strategies 2 and 3 would avert 13 SCDs per 400 000 children seeking stimulant treatment for ADHD, for a cost of $1.6 million per life for strategy 2 and $1.2 million per life for strategy 3. Conclusions-Relative to current practice, adding ECG screening to history and physical examination pretreatment screening for children with attention deficit/hyperactivity disorder has borderline cost-effectiveness for preventing SCD. Relative cost-effectiveness may be improved by basing cardiology referral on ECG alone. Benefits of ECG screening arise primarily by restricting children identified with SCD risk from competitive sports. (Circulation. 2010;121:1329-1337.)

show abstract

A Modeled Economic Evaluation Comparing Atomoxetine with Stimulant Therapy in the Treatment of Children with Attention-Deficit/Hyperactivity Disorder in the United Kingdom

Abstract: The economic evaluation showed atomoxetine is an effective alternative across a range of ADHD populations and offers value-for-money in the treatment of ADHD.

Cited by 28 publications

References 28 publications

Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder

Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder

Probing Compulsive and Impulsive Behaviors, from Animal Models to Endophenotypes: A Narrative Review

Modeled Economic Evaluation of Alternative Strategies to Reduce Sudden Cardiac Death Among Children Treated for Attention Deficit/Hyperactivity Disorder

Contact Info

Product

Resources

About