Treatment for ADHD: Is More Complex Treatment Cost‐Effective for More Complex Cases?

Foster, E. Michael; Jensen, Peter S.; Schlander, Michael; Pelham, William E.; Hechtman, Lily; Arnold, L. Eugene; Swanson, James M.; Wigal, Timothy

doi:10.1111/j.1475-6773.2006.00599.x

Cited by 49 publications

(51 citation statements)

References 30 publications

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“…A further review of these 45 published full-text reports excluded 32 conference submissions, abstracts or review articles and 13 full-text studies were included in the final review (figure 1). [53][54][55][56][57][58][59][60][61][62][63][64][65] To facilitate comparisons across studies, costs were reported in the original currency as well as in 2010 US dollars. Costs in non-US currencies were first converted to US dollars in the same year based on the annual exchange rate in that year.…”

Section: Methodsmentioning

confidence: 99%

“…behavioural or community care] (6), [55,57,58,[63][64][65] stimulants versus non-stimulants (3) [60][61][62] and stimulants versus stimulants (7). [54][55][56][57][58][59]62] Several studies included more than one category.…”

Section: Characteristics Of Identified Cost-effectiveness Studiesmentioning

confidence: 99%

“…[54][55][56][57][58][59]62] Several studies included more than one category. [54,55,57,58,[60][61][62] The majority of studies were conducted in the US (4) [54,56,64,65] and UK (5); [53,57,60,62,63] the remaining studies were conducted in Canada (1), [55] Australia (1), [58] the Netherlands (1) [59] and Spain (1). [61] Six studies conducted cost-utility analyses (CUAs) using quality-adjusted life-year (QALY) as the effectiveness measure.…”

Section: Characteristics Of Identified Cost-effectiveness Studiesmentioning

confidence: 99%

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Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder

Hodgkins

Ben-Hamadi

et al. 2012

CNS Drugs

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Among children and adolescents with ADHD, there was consistent evidence that pharmacotherapies are cost effective compared with no treatment or behavioural therapy. Adequate data are lacking to draw conclusions regarding the relative cost effectiveness of different pharmacological agents. More economic evaluations with standardized methods, such as effectiveness measures and cost components, are warranted. To better inform payers about the economic value of existing medications, future studies should also consider identifying subgroups that may have heterogeneous responses to different treatments, including analyses of recently approved treatments (e.g. lisdexamfetamine, guanfacine extended-release and clonidine extended-release) and expanding the time horizon to incorporate long-term outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Characteristics Of Identified Cost-effectiveness Studiesmentioning

confidence: 99%

Section: Characteristics Of Identified Cost-effectiveness Studiesmentioning

confidence: 99%

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Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder

Hodgkins

Ben-Hamadi

et al. 2012

CNS Drugs

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“…First, comprehensive screening for other problems that occur with ADHD is necessary, and treat- ment profiles should be tailored by comorbidity status and levels of functional impairment in home and school settings. [51][52][53][54] Current AAP guidelines call for assessment and management of comorbidity with ADHD. 55,56 Most physicians report screening for common comorbidities such as depression, 57 but only 20% agree that they are adequately trained to treat children with ADHD and comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:Attention-deficit/ hyperactivity disorder (ADHD) is known to be associated with a range of mental health and neurodevelopmental comorbidities, but the pattern of these comorbidities and their relationship to child and family functioning and service use at the population level investigated has not been found in previous studies. WHAT THIS STUDY ADDS:Two-thirds of US children with ADHD have comorbid conditions. Social and educational functioning declines with more comorbidities and cross-sector service use and need for care coordination increase. Management of ADHD should be tailored to each child's neurodevelopmental profile. abstract OBJECTIVE: To determine patterns of comorbidity, functioning, and service use for US children with attention-deficit/hyperactivity disorder (ADHD). METHODS:Bivariate and multivariable cross-sectional analyses were conducted on data from the 2007 National Survey of Children's Health on 61 779 children ages 6 to 17 years, including 5028 with ADHD. RESULTS:Parent-reported diagnosed prevalence of ADHD was 8.2%. Children with ADHD were more likely to have other mental health and neurodevelopmental conditions. Parents reported that 46% of children with ADHD had a learning disability versus 5% without ADHD, 27% vs 2% had a conduct disorder, 18% vs 2% anxiety, 14% vs 1% depression, and 12% vs 3% speech problems (all P Ͻ .05). Most children with ADHD had at least 1 comorbid disorder: 33% had 1, 16% had 2, and 18% had 3 or more. The risk for having 3 or more comorbidities was 3.8 times higher for poor versus affluent children (30% vs 8%). Children with ADHD had higher odds of activity restriction (odds ratio: 4.14 [95% confidence interval: 3.34 -5.15]), school problems (odds ratio: 5.18 [95% confidence interval: 4.47-6.01]), grade repetition, and poor parent-child communication, whereas social competence scores were lower and parent aggravation higher. Functioning declined in a stepwise fashion with increasing numbers of comorbidities, and use of health and educational services and need for care coordination increased. CONCLUSIONS:Clinical management of ADHD must address multiple comorbid conditions and manage a range of adverse functional outcomes. Therapeutic approaches should be responsive to each child's neurodevelopmental profile, tailored to their unique social and family circumstances, and integrated with educational, mental health and social support services.

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“…Since behavioral intervention programs can be quite costly ($10,000 or more per child) (Aos et al 2004), their cost effectiveness depends on identifying and targeting those youth for whom the intervention generates the largest returns (Foster and Jones 2006). Similarly, some types of intervention for a mental disorder may depend on the presence or absence of comorbidities (Foster et al 2007). …”

mentioning

confidence: 99%

Semi-parametric regression as a tool for assessing moderation: an analysis of the Fast Track intervention

Foster

Watkins

2010

Health Serv Outcomes Res Method

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When assessing the impact of a family or youth intervention, program evaluators often consider whether and how baseline characteristics moderate the effect of treatment. Parametric and non-parametric approaches are both possible, but each has limitations. In this article, we argue for and illustrate the use of semi-parametric methods. A hybrid of parametric and non-parametric approaches, semi-parametric modeling techniques combine the strengths of each approach. This article demonstrates how this approach can be used to evaluate whether an intervention effect was larger for those with most serious problems at baseline. Using data from the Fast Track project-a comprehensive intervention designed to prevent serious conduct problems among children at high risk-we investigated the moderating effect of two key baseline characteristics: parent-reported and teacher-reported problem behavior. Our analyses do not demonstrate a significant moderation of the intervention effect.

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Treatment for ADHD: Is More Complex Treatment Cost‐Effective for More Complex Cases?

Cited by 49 publications

References 30 publications

Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder

Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder

Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007

Semi-parametric regression as a tool for assessing moderation: an analysis of the Fast Track intervention

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