The Pharmaceutical Economics of Child Psychiatric Drug Treatment

Abstract

The last decade, the number of health economic evaluations has increased substantially in the field of child psychiatry. The objective of the present paper is to offer an overview of economic evaluations of child psychiatric drug treatment. Major electronic databases, as well as abstract booklets from international clinical and health economics conferences with an external peer review process, were examined to search for comparative economic evaluations of child and adolescent psychiatric drug treatment. Most studies of pharmacotreatment were cost effectiveness analyses (CEAs) concerned with attention-deficit/hyperactivity disorder (ADHD). Three evaluations were done by or on behalf of agencies as part of ADHD-related health technology assessments. A number of economic studies used patient-level data from specific randomized clinical trials, especially the NIMH-initiated MTA (in childhood ADHD) and TADS (in adolescent major depression) studies. Almost all studies relied on narrow scale symptom scales to assess effects of treatment, even when quality-adjusted life years (QALYs) were reported. In many cases, effectiveness data came from short-term studies, and extrapolation to a one-year time horizon was usually based on assumptions. Even those evaluations attempting to address longer time horizons by way of modeling did not include the impact of treatment on long-term sequelae of the conditions studied, mainly due to a paucity of robust clinical data. Nevertheless, currently available health economic evaluations broadly suggest an acceptable to attractive cost effectiveness of medication management of ADHD, whereas there is no such evidence for child psychiatric disorders other than ADHD.

Annual Research Review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders

“…However, these disorders are less well served by cost‐related research than ASD, CD or ADHD, although both have implications for poorer adult health and quality of life. The question of how best to use resources to treat these disorders in childhood also remains unanswered, even when considering medication (see also, Schlander, ; p2455). This absence of research evidence hampered provision of value for money advice to health policy makers in Australia and the authors had to draw on adult studies for some parameters in their analysis of childhood depression (p. e724, Mihalopoulos, Vos, Pirkis, & Carter, ).…”

“…They also suggest that to develop the limited evidence base, guidelines might improve the quality of economic evaluations, and help ensure that an economic evaluation always accompanies an effectiveness study. Four other focussed reviews of economic evaluations have been published since 2009: two considered the economic evidence for parenting programmes to intervene in childhood behaviour problems (Charles et al., ; Stevens, ); and two reviewed studies of medication (Schlander, ; Wu et al, ). All four of these reviews found full cost‐effectiveness analyses to be rare and methodological problems to be common.…”

“…Evaluations of psychiatric medication were excluded. Most such evaluations have a narrow payer‐only perspective (Wu et al., ); the majority focus on medication for ADHD (Schlander, ).…”