The cost-effectiveness of treatments for pediatric ADHD: the effects of gender and comorbidity

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  • March 22, 2019
Creator
  • Leinwand, Brian
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy
Abstract
  • Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder among children. The condition can last well into adulthood, generating significant healthcare and societal costs. Treatments can include medications, cognitive-behavioral therapy or a combination of the two. The goal of treatment is to reduce symptoms that cause academic, social and emotional impairment. Comorbid psychiatric conditions can complicate treatment and generate additional costs. Most research focuses on boys, although the disorder occurs frequently in girls. Research suggests boys are more impaired in some symptom domains, while girls appear more impaired in others. A limited literature exists on the cost-effectiveness of different treatments for ADHD, and each study uses a short time horizon. The objective of this paper is to use discrete event simulation to model the long-term cost-effectiveness of two ADHD treatment modalities, accounting for gender and comorbidities. Data from the Multimodal Treatment Study of Children with ADHD and cost estimates from the literature were used to model the costs and outcomes of medication and combination therapy. Treatment response was estimated via mixed-effects logistic regression as a function of gender, comorbidity status, ADHD severity, and treatment compliance. Costs of clinician visits, medications, special education, juvenile justice, hospitalizations, and parental work productivity losses were estimated from the data and literature. A discrete-event simulation modeled patients moving through the healthcare system over eight years to determine the long-term cost-effectiveness of the treatment modalities. The treatments performed similarly; both treatment arms produced successful responses between 3.8 - 4.4 years of the time horizon. However, the 8-year treatment costs among patients on combination therapy were significantly higher than patients on medications alone ($39,000 vs. $22,000). Additionally, the 8-year non-treatment costs among patients on combination therapy were significantly higher than patients on medications alone ($17,000 vs. $14,000). Costs and response rates did not differ by gender and comorbidity; however, data on gender-comorbidity subgroups were constrained by small sample sizes. The incremental cost-effectiveness ratios indicated that medication management was more cost-effective than combination therapy for boys and girls over an 8-year time horizon. Ultimately, limited resources can be used more efficiently when children are treated with medications alone.
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  • In Copyright
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  • " ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy of Pharmaceutical Sciences in the School of Pharmacy (Division of Pharmaceutical Outcomes and Policy)."
Advisor
  • Hansen, Richard A.
Degree granting institution
  • University of North Carolina at Chapel Hill
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  • Chapel Hill, NC
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  • Open access
Date uploaded
  • March 18, 2013

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