title: A Cost-Utility Analysis of Lisdexamfetamine Versus Atomoxetine in the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Inadequate Response to Methylphenidate.
abstract: An economic analysis from the perspective of the UK National Health Service (NHS) evaluated the cost effectiveness of lisdexamfetamine dimesylate (LDX) compared with atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder who have had an inadequate response to methylphenidate.
  
  
  
  A 1-year decision-analytic model was constructed, with the health outcomes "response", "nonresponse", and "unable to tolerate". Clinical data were taken from a head-to-head, randomized controlled trial in inadequate responders to methylphenidate. Response to treatment was defined as a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement subscale. Tolerability was assessed by discontinuation rates owing to adverse events. Utility weights were identified via a systematic literature review. Healthcare resource use estimates were obtained via a survey of clinicians. Daily drug costs were derived from British National Formulary 2012 costs and mean doses reported in the trial. One-way and probabilistic sensitivity analyses (PSAs) were performed.
  
  
  
  The comparison of LDX with atomoxetine resulted in an estimate of an incremental cost-effectiveness ratio of £1802 per quality-adjusted life-year (QALY). The result was robust in a wide range of sensitivity analyses; results were most sensitive to changes in drug costs and efficacy. In the PSA, assuming a maximum willingness to pay of £20,000 per QALY, LDX versus atomoxetine had an 86 % probability of being cost effective. In 38 % of PSA runs, LDX was more effective and less costly than atomoxetine.
  
  
  
  From the perspective of the UK NHS, LDX provides a cost-effective treatment option for children and adolescents who are inadequate responders to methylphenidate.
authors.affiliation: Market Access and Outcomes Strategy, RTI Health Solutions, 2nd Floor, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK. ezimovetz@rti.org.
authors.forename: Evelina A
authors.initials: EA
authors.lastname: Zimovetz
authors.affiliation: RTI Health Solutions, Sheffield, UK.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Beard
authors.affiliation: Global HEOR and Epidemiology, Shire, Wayne, PA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgkins
authors.affiliation: Global HEOR and Epidemiology, Shire, Zug, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bischof
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Josephine A
authors.initials: JA
authors.lastname: Mauskopf
authors.affiliation: Global HEOR and Epidemiology, Shire, Wayne, PA, USA.
authors.forename: Juliana
authors.initials: J
authors.lastname: Setyawan
mesh_terms: D000293:Adolescent; D000069445:Atomoxetine Hydrochloride / Q000191:economics / Q000627:therapeutic use; 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; D005260:Female; D006295:Health Resources / Q000191:economics; D006801:Humans; D000069478:Lisdexamfetamine Dimesylate / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D011336:Probability; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride; D000069478:Lisdexamfetamine Dimesylate