The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review

Abstract

Economic evaluations can help decision makers identify what services for children with neurodevelopmental disorders provide best value-for-money. The aim of this paper is to review the best available economic evidence to support decision making for attention deficit-hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children and adolescents. We conducted a systematic review of economic evaluations of ADHD and ASD interventions including studies published 2010–2020, identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and consequences were included. The quality of the studies was assessed using the Drummond checklist. We identified ten studies of moderate-to-good quality on the cost-effectiveness of treatments for ADHD and two studies of good quality of interventions for ASD. The majority of ADHD studies evaluated pharmacotherapy (n = 8), and two investigated the economic value of psychosocial/behavioral interventions. Both economic evaluations for ASD investigated early and communication interventions. Included studies support the cost-effectiveness of behavioral parenting interventions for younger children with ADHD. Among pharmacotherapies for ADHD, different combinations of stimulant/non-stimulant medications for children were cost-effective at willingness-to-pay thresholds reported in the original papers. Early intervention for children with suspected ASD was cost-effective, but communication-focused therapy for preschool children with ASD was not. Prioritizing more studies in this area would allow decision makers to promote cost-effective and clinically effective interventions for this target group.

The Lancet Commission on the future of care and clinical research in autism

“…The situation is not helped by the paucity of costeffectiveness evidence. A systematic review focused on children and adolescents 351 identified only two robust studies: one randomised controlled trial-based evaluation that suggested that the Preschool Autism Communication Trial intervention did not appear to be cost-effective in the short-term when added to treatment as usual, 273 and another that used modelling to estimate the potential costs and benefits of developmental early intervention programmes (ie, Early Start Denver Model) up to the age of 65 years, concluding that there would be cost savings and cost-effectiveness gains. 352 Another modelling study concluded that, even under optimistic assumptions, applied behaviour analysis was not cost-effective.…”

The Epigenome in Neurodevelopmental Disorders

“…Therefore, future research needs to identify molecular signal cascades and their connection to epigenetic modifications in the healthy and diseased brain. This also includes analyses of spatiotemporal dynamics of epigenetic mechanisms and patterns, hopefully elucidating cause, prevention or treatment of NDDs to increase quality of life for affected individuals and families ( Lamsal and Zwicker, 2017 ; Sampaio et al, 2021 ).…”

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

“…While there are now studies on adult treatments, a recent systematic review (Sampaio et al 2021) did not include these, and, importantly, included literature from a very limited time period (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020). Although data on adult treatments were included in the systematic review of Klora et al (2016), this review again only focused on pharmacological treatments.…”