Cost-effectiveness of dexamphetamine and methylphenidate for the treatment of childhood attention deficit hyperactivity disorder.
OBJECTIVE
To analyze from a health sector perspective the cost-effectiveness of dexamphetamine (DEX) and methylphenidate (MPH) interventions to treat childhood attention deficit hyperactivity disorder (ADHD), compared to current practice.


METHODS
Children eligible for the interventions are those aged between 4 and 17 years in 2000, who had ADHD and were seeking care for emotional or behavioural problems, but were not receiving stimulant medication. To determine health benefit, a meta-analysis of randomized controlled trials was performed for DEX and MPH, and the effect sizes were translated into utility values. An assessment on second stage filter criteria ("equity", "strength of evidence", "feasibility" and "acceptability to stakeholders") is also undertaken to incorporate additional factors that impact on resource allocation decisions. Simulation modelling techniques are used to present a 95% uncertainty interval (UI) around the incremental cost-effectiveness ratio (ICER), which is calculated in cost (in A$) per DALY averted.


RESULTS
The ICER for DEX is A$4100/DALY saved (95% UI: negative to A$14 000) and for MPH is A$15 000/DALY saved (95% UI: A$9100-22 000). DEX is more costly than MPH for the government, but much less costly for the patient.


CONCLUSIONS
MPH and DEX are cost-effective interventions for childhood ADHD. DEX is more cost-effective than MPH, although if MPH were listed at a lower price on the Pharmaceutical Benefits Scheme it would become more cost-effective. Increased uptake of stimulants for ADHD would require policy change. However, the medication of children and wider availability of stimulants may concern parents and the community.
Health Surveillance and Evaluation Section, Public Health, Department of Human Services, Melbourne, Australia.
Marie
M
Donnelly
Michelle M
MM
Haby
Rob
R
Carter
Gavin
G
Andrews
Theo
T
Vos
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003913:Dextroamphetamine / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008605:Mental Health Services / Q000191:economics*; D008774:Methylphenidate / Q000191:economics* / Q000627:therapeutic use*; D009010:Monte Carlo Method; D010349:Patient Compliance / Q000706:statistics & numerical data
D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D003913:Dextroamphetamine