title: Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil.
abstract: OBJECTIVE
  To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil.
  
  
  METHODS
  A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years.
  
  
  RESULTS
  Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy.
  
  
  CONCLUSIONS
  MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy.
  
  
  BACKGROUND
  NCT01705613.
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Maia
authors.affiliation: Instituto de Avaliação de Tecnologia em Saúde (IATS), Instituto de Avaliação de Tecnologia em Saúde (IATS), Porto Alegre, RS, Brazil.
authors.forename: Steffan F
authors.initials: SF
authors.lastname: Stella
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
authors.forename: Flavia
authors.initials: F
authors.lastname: Wagner
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
authors.forename: Thiago G
authors.initials: TG
authors.lastname: Pianca
authors.affiliation: Graduate Program in Psychiatry, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Fernanda V
authors.initials: FV
authors.lastname: Krieger
authors.affiliation: Instituto de Avaliação de Tecnologia em Saúde (IATS), Instituto de Avaliação de Tecnologia em Saúde (IATS), Porto Alegre, RS, Brazil.
authors.forename: Luciane N
authors.initials: LN
authors.lastname: Cruz
authors.affiliation: USP, São Paulo, SP, Brazil.
authors.forename: Guilherme V
authors.initials: GV
authors.lastname: Polanczyk
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
authors.forename: Luís A
authors.initials: LA
authors.lastname: Rohde
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
authors.forename: Carísi A
authors.initials: CA
authors.lastname: Polanczyk
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics; D001938:Brazil; D000697:Central Nervous System Stimulants / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008390:Markov Chains; D008774:Methylphenidate / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity
chemical_list: D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations; D008774:Methylphenidate