Cost-Effectiveness of Treatments in Children With Attention-Deficit/Hyperactivity Disorder: A Continuous-Time Markov Modeling Approach

Abstract

Objectives. This study aimed to assess the cost-effectiveness of treatments for attention-deficit/hyperactivity disorder (ADHD) in children through prevention of serious delinquent behavior. Cost-effectiveness was assessed in net-monetary benefit (NMB). Methods. To evaluate the three major forms of ADHD treatment (medication management, behavioral treatment, and the combination thereof) relative to community-delivered treatment (control condition), we used data from 448 children, aged 7 to 10, who participated in the National Institute of Mental Health’s Multimodal Treatment Study of Children with ADHD. We developed a three-state continuous-time Markov model (no delinquency, minor to moderate delinquency, serious delinquency) to extrapolate the results 10 years beyond the 14-month trial period at a 3% discount rate. Serious delinquency was considered an absorbing state to enable assessment in life-years (LYs) of serious delinquent behavior prevented. The willingness-to-pay (WTP) threshold was set equal to the annual cost associated with serious delinquency in children with ADHD of $12,370. Results. Modeled and observed outcomes matched closely with a mean difference of 6.9% in LYs of serious delinquent behavior prevented. The economic evaluation revealed a NMB of $95,449, $88,553, $90,536 and $98,660 for medication management, behavioral treatment, combined treatment, and routine community care, respectively. Estimates remained stable after linearly increasing the WTP threshold between $0 and $50,000 in the deterministic sensitivity analyses. Conclusions. This study assessed the cost-effectiveness of treatments for ADHD in children using continuous-time Markov modeling. We show that treatment evaluation in broader societal outcomes is essential for policy makers, as the three major forms of ADHD treatment turned out to be inferior to the control condition.

Cost-effectiveness analysis of paediatric mental health interventions: a systematic review of model-based economic evaluations

“… Health care system Family therapy (FT) delivered by trained and supervised family therapists ( n = 415) Treatment as usual (TAU) offered by local CAMHS following self-harm ( n = 417) Both cost and effects 3.5% 12 Freriks RD. et al, 2019 [ 37 ] USA Health care setting Children 7–10 years, participated in Multimodal Treatment Study of Children With ADHD in United States Not explicitly stated. But mentioned as societal cost and outcome in the abstract and discussion sections.…”

“… Trial data and published literature Participant cost and utility data were available at 6, 12 and 18 months from the trial data and were directly included into the model to estimate longer-term costs and health benefits British pounds QALY gained 12 Freriks RD. et al, 2019 [ 37 ] Markov model 10 years beyond the 14-month trial period Trial data- from a USA study, published literature and existing databases Disease probabilities and treatment costs from trial data Criminal related cost-trial data- published literature and existing databases. US dollars (Not mentioned) Life-years of serious delinquent behavior prevented ADIS Anxiety Disorder Interview Schedule, CBT cognitive behavioral therapy, DALYs Disability-adjusted life years, PTSD post traumatic stress disorder, QALYs Quality adjusted life years *Details related to economic evaluation of children category is only reported here …”

“…Health state utilities in treatment as usual arm 6 months- SH 0.760 (SE 0.161) 12 months- SH 0.751 (SE 0.187) noSH 0.784 (SE 0.180) Death 0 18 months- SH 0.754 (SE 0.033) noSH 0.808 (SE 0.157) Death 0 Health state utilities in family therapy arm 6 months- SH 0.799 (SE 0.178) 12 months- SH 0.793 (SE 0.184) noSH 0.813 (SE 0.194) Death 0 18 months- SH 0.732 (SE 0.239) noSH 0.823 (SE 0.179) Death 0 9 Freriks RD. et al, 2019 [ 37 ] Three health states No delinquency Minor to moderate delinquency Serious delinquency Not applicable as the outcome is life-years of serious delinquent behavior prevented DALYs Disability-adjusted life years, PTSD post traumatic stress disorder, QALYs Quality adjusted life years …”

“…The model used three delinquency related health states (no delinquency, mild to moderate delinquency, and serious delinquency) and the main effect measure was life-years (LYs) of serious delinquent behaviour prevented (Table 3 ). Of note was the inclusion of serious delinquency state as the absorbing health state for the Markov model in this study [ 37 ]. Of the two studies in this group, one [ 37 ] performed DSA, whereas the other [ 33 ] performed both DSA and PSA to assess the parameter uncertainty (Supplementary Table 1 ).…”

“…Of note was the inclusion of serious delinquency state as the absorbing health state for the Markov model in this study [ 37 ]. Of the two studies in this group, one [ 37 ] performed DSA, whereas the other [ 33 ] performed both DSA and PSA to assess the parameter uncertainty (Supplementary Table 1 ).…”