title: A modeled economic evaluation comparing atomoxetine with stimulant therapy in the treatment of children with attention-deficit/hyperactivity disorder in the United Kingdom.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of atomoxetine for children with attention-deficity/hyperactivity disorder (ADHD) in the United Kingdom compared with current alternatives.
  
  
  METHODS
  An economic model with Markov processes was developed to estimate the costs and benefits of atomoxetine versus other current ADHD treatment options. The model evaluated atomoxetine in five patient subgroups according to treatment history and the existence of comorbidities precluding stimulant medication. The incremental cost per quality-adjusted life-year (QALY) was calculated for atomoxetine treatment algorithms compared with comparator algorithms. The Markov process incorporated 18 health states, representing a range of outcomes across all treatment options included in the algorithms. Utility values were derived from a survey of 83 parents of children with ADHD. The effectiveness and safety aspects of the treatment options were based on a thorough review of controlled clinical trials and other clinical literature, and validated by international experts. Costs and outcomes were estimated using Monte Carlo simulation over a 1-year duration, with costs estimated from the perspective of the National Health Service in England and Wales.
  
  
  RESULTS
  For stimulant-naive patients, the incremental cost per QALY gained for the atomoxetine algorithm compared with immediate-release methylphenidate hydrochloride (MPH) was pound 15,224 ( pound 13,241 compared with extended-release MPH). In the stimulant-exposed populations, the incremental cost per QALY for the atomoxetine algorithm was between pound 14,169 and pound 15,878. For patients contraindicated for stimulant therapies, the incremental cost per QALY was pound 11,523 and pound 12,370 for stimulant-naive and stimulant-exposed populations, respectively.
  
  
  CONCLUSIONS
  The economic evaluation showed atomoxetine is an effective alternative across a range of ADHD populations and offers value-for-money in the treatment of ADHD.
authors.affiliation: IMS Health, London, UK. scottrell@uk.imshealth.com
authors.forename: Suzi
authors.initials: S
authors.lastname: Cottrell
authors.forename: Dominic
authors.initials: D
authors.lastname: Tilden
authors.forename: Paul
authors.initials: P
authors.lastname: Robinson
authors.forename: Jay
authors.initials: J
authors.lastname: Bae
authors.forename: Jorge
authors.initials: J
authors.lastname: Arellano
authors.forename: Eric
authors.initials: E
authors.lastname: Edgell
authors.forename: Mike
authors.initials: M
authors.lastname: Aristides
authors.forename: Kristina S
authors.initials: KS
authors.lastname: Boye
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D000465:Algorithms; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics*; D000697:Central Nervous System Stimulants / Q000191:economics* / Q000627:therapeutic use*; D002648:Child; D003362:Cost-Benefit Analysis; D006801:Humans; D008390:Markov Chains; D008774:Methylphenidate / Q000191:economics* / Q000627:therapeutic use*; D018803:Models, Economic; D009010:Monte Carlo Method; D011437:Propylamines / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D011437:Propylamines; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride