Cost-utility analysis of methylphenidate and amphetamine/dexamphetamine in adults with attention-deficit hyperactivity disorder

Abstract

Objectives Methylphenidate (MPH) and amphetamine/dexamphetamine (AMP/DEX) are the two most common stimulants used to treat attention‐deficit hyperactivity disorder (ADHD). Previous economic evaluations of these treatments mainly focused on children and adolescents. The objective of this study was to conduct a cost–utility analysis of MPH and AMP/DEX treatments in adults with ADHD. Methods This study was conducted from a third‐party payer perspective using the Medical Expenditure Panel Survey from 2011 to 2013. Patients taking MPH or AMP/DEX were identified from the Prescribed Medicines files. The Short Form‐12 version 2 questionnaire scores were used to calculate quality‐adjusted life years (QALYs). Only direct costs were evaluated from payer's perspective. Incremental cost–utility ratios were calculated, and sensitivity analyses were performed to assess the robustness of the findings at different willingness to pay (WTP) assumptions. Key findings Of 305 patients, 68.8% were in the AMP/DEX group and 31.2% were in MPH group. The mean annual cost for the MPH group was $4355.31, and the cost for the AMP/DEX group was $6026.40. The mean utilities for MPH and AMP/DEX groups were 0.622 and 0.598 respectively. Sensitivity analyses showed that MPH exceeded AMP/DEX at all WTP values. Conclusion Methylphenidate was clearly a dominating therapy over AMP/DEX; however, the QALY difference was found to be 0.024. Further research is needed to assess the long‐term impact of using these treatments on various clinical and economic outcomes.

Cost-Effectiveness and Cost Utility of Treatment of Attention-Deficit/Hyperactivity Disorder: A Systematic Review

“…As ADHD is a disorder that often persists into adulthood and awareness of ADHD in adults is growing (Willcutt 2012; American Psychiatric Association 2013), it is surprising that at this point, conclusions about cost-effective adult ADHD treatments have to be drawn with caution. We only included four studies that addressed different treatments with various comparators for adults with ADHD (Shah et al 2017;Tockhorn et al 2014;Zimovetz et al 2018;Janssen et al 2019). Although these studies suggest that there are costeffective treatments for adults, more studies on most common options (e.g., medication) are warranted to draw unambiguous conclusions.…”

“…All studies found that methylphenidate ER was cost-effective for our WTP threshold, where two studies (Schawo et al 2015;van der Schans et al 2015) even found that methylphenidate ER dominated methylphenidate IR, in that methylphenidate ER yielded lower incremental costs and higher benefits. Using a third-party payer perspective for the United States and a time horizon of 1 year, Shah et al (2017) also found that methylphenidate ER dominated amphetamine/dexamphetamine in adults. Thus, methylphenidate ER was more effective and less costly than the alternative.…”

“…Generally, in children and adolescents, research on cost-effectiveness of stimulant treatment compared to other stimulant treatment is mixed and limited, although methylphenidate ER appears to be cost-effective when compared to methylphenidate IR (Faber et al 2008;Schawo et al 2015;van der Schans et al 2015). Evidence on the cost-effectiveness of stimulants on adults is extremely limited, as only two studies focused on adults (Shah et al 2017;Zimovetz et al 2018).…”

Mindfulness-Based Cognitive Therapy Versus Treatment as Usual in Adults with ADHD: a Trial-Based Economic Evaluation

“…Although pharmacotherapy with stimulants has proven to be effective in the short term (Faraone and Glatt 2010;Moriyama et al 2013), current guidelines emphasize that drug treatment should be part of a multimodal treatment (Kooij et al 2010; National Institute for Health and Care Excellence [NICE] 2018; Nederlandse Vereniging voor Psychiatrie [NVvP] 2015). Only one study conducted an economic evaluation of pharmacotherapy in adults with ADHD (Shah et al 2017) and no studies to date have conducted an economic evaluation of additional psychosocial treatment options in an adult ADHD population.…”