title: A cost-effectiveness analysis of lisdexamfetamine dimesylate in the treatment of adults with attention-deficit/hyperactivity disorder in the UK.
abstract: BACKGROUND
  Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder in children that may persist into adulthood. Lisdexamfetamine dimesylate (LDX) is approved in many countries for ADHD treatment in children, adolescents, and adults.
  
  
  OBJECTIVE
  Estimate the cost-effectiveness of LDX as a first- or second-line treatment for adults with ADHD from the United Kingdom (UK) National Health Service (NHS) perspective compared with methylphenidate extended release (MPH-ER) and atomoxetine (ATX).
  
  
  METHODS
  A 1-year decision-analytic model was developed. Health outcomes included response, non-response and inability to tolerate. Efficacy data were obtained from a mixed-treatment comparison (MTC). Response was a score of 1 or 2 on the Clinical Global Impression-Improvement scale. Tolerability was assessed by discontinuation rates due to adverse events. Utilities were identified via a systematic literature review. Health care resource use estimates were obtained via a survey of clinicians. Daily drug costs were estimated from mean doses reported in the trials used in the MTC. One-way and probabilistic sensitivity analyses (PSAs) were performed.
  
  
  RESULTS
  LDX dominated MPH-ER and ATX; reducing mean per-patient annual cost by £5 and £200, and increasing mean quality-adjusted life years (QALYs) by 0.005 and 0.009, respectively. In the PSA, the probability of cost-effectiveness for LDX vs. MPH-ER and ATX at a threshold of £20,000 per QALY was 61% and 80%, respectively.
  
  
  CONCLUSIONS
  From the perspective of the UK NHS, LDX is likely to provide a cost-effective treatment for adults with ADHD. This conclusion may be drawn with more certainty in comparison with ATX than with MPH-ER.
authors.affiliation: 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: Shire, Zählerweg 10, 6301, Zug, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Joseph
authors.affiliation: Analysis Group, Inc., 111 Huntington Ave, 10th Floor, Boston, MA, 02199, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Ayyagari
authors.affiliation: RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC, 27709, USA.
authors.forename: Josephine A
authors.initials: JA
authors.lastname: Mauskopf
mesh_terms: D000328:Adult; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006801:Humans; D000069478:Lisdexamfetamine Dimesylate / Q000191:economics* / Q000627:therapeutic use; D012196:Review Literature as Topic; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000697:Central Nervous System Stimulants; D000069445:Atomoxetine Hydrochloride; D000069478:Lisdexamfetamine Dimesylate
keywords: ADHD; Adult; Attention-deficit/hyperactivity disorder; Cost-effectiveness analysis; Economic evaluation; Lisdexamfetamine