Comparative Cost Analysis of Sequential, Adaptive, Behavioral, Pharmacological, and Combined Treatments for Childhood ADHD

Abstract

Objective We conducted a cost-analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment randomized, and adaptive trial investigating the sequencing and enhancement of treatment for ADHD children (Pelham et al., under review; N=152, 76% male, 80% Caucasian). Methods The quantity of resources expended on each child’s treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Results Beginning treatment with a low-intensity regimen of behavior modification (group parent training) was less costly for a school-year of treatment ($961) than beginning treatment with a low dose of stimulant medication ($1689), regardless of whether the initial treatment was intensified with a higher “dose” or if the other modality was added. Conclusions Outcome data from the parent study (Pelham et al., under review) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings document that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD.

ADHD: Overdiagnosed and overtreated, or misdiagnosed and mistreated?

“…Findings also indicate that starting with behavioral therapy increases the cost-effectiveness of treatment for children with ADHD. 38 In the long term, combination therapy leads to better outcomes 38 and enables the use of lower medication dosages to achieve results similar to those with drug therapy alone (Figure 2). [39][40][41] Behavioral intervention has modest advantages over medicine for non-ADHD symptoms, 42 as the practice satisfi es the adage "pills don't teach skills."…”

Adaptive Interventions in Child and Adolescent Mental Health

“…For example, response vs. non-response is measured monthly, and children may transition to second stage treatment at different time points. In a second manuscript by the same research team (Page et al, 2015), cost outcomes are presented. Together, the two manuscripts begin to shed light on the cost-effectiveness of different adaptive interventions in children with ADHD.…”

Vital Signs: National and State-Specific Patterns of Attention Deficit/Hyperactivity Disorder Treatment Among Insured Children Aged 2–5 Years — United States, 2008–2014

“…In addition, young children are more susceptible to adverse health effects of ADHD medications, whereas adverse health effects have not been reported for parent behavior training (12). ADHD treatment with behavior therapy, which is typically limited in duration, might be associated with better school outcomes (23) and more cost-effective over a school year than treatment with ongoing medication (24). Further, behavior therapy can also improve problematic behavior in young children who present with symptoms that look like ADHD, such as symptoms of anxiety and oppositional defiant disorder.…”