Foster E Michael, Jensen Peter S, Schlander Michael, Pelham William E, Hechtman Lily, Arnold L Eugene, Swanson James M, Wigal Timothy
Department of Maternal and Child Health, The University of North Carolina, School of Public Health, 407-C Rosenau Hall, CB 7445, Chapel Hill, NC 27599, USA.
Health Serv Res. 2007 Feb;42(1 Pt 1):165-82. doi: 10.1111/j.1475-6773.2006.00599.x.
To determine the cost-effectiveness of three alternative high-quality treatments for attention deficit hyperactivity disorder (ADHD) relative to community care (CC) and to determine whether cost-effectiveness varies with the presence of comorbid disorders. DATA SOURCES/COLLECTION: The study included 579 children ages 7-9.9 with diagnosed ADHD at six sites. Data for the study were distilled from administrative data and from interviews with parents, including estimates of the child's functional impairment. These analyses focus on changes in functional impairment over 14 months.
The study involved a large clinical trial that randomized participants to one of four arms: routine CC, intensive medication management (MedMgt), multicomponent behavioral treatment, and a combination of behavioral treatment and medication.
We assessed the cost-effectiveness of the alternatives using costs measured from a payer perspective. The preferred cost-effective treatment varies as a function of the child's comorbidity and of the policy maker's willingness to pay. For pure (no comorbidity) ADHD, high-quality MedMgt appears likely to be cost-effective at all levels of willingness to pay. In contrast, for some comorbid conditions, willingness to pay is critical: the policy maker with low willingness to pay likely will judge MedMgt most cost-effective. On the other hand, a policy maker willing to pay more now in expectation of future costs savings (involving, for example, juvenile justice), will recognize that the most cost-effective choice for comorbid conditions likely involves behavior therapy, with or without medication.
Analyses of costs and effectiveness of treatment for ADHD must consider the role of comorbidities.
确定三种治疗注意力缺陷多动障碍（ADHD）的高质量替代疗法相对于社区护理（CC）的成本效益，并确定成本效益是否因共病情况而异。数据来源/收集：该研究纳入了六个地点的579名7至9.9岁被诊断患有ADHD的儿童。研究数据来自行政数据和对家长的访谈，包括对儿童功能损害的评估。这些分析聚焦于14个月内功能损害的变化。
该研究涉及一项大型临床试验，将参与者随机分为四组：常规社区护理、强化药物管理（MedMgt）、多成分行为治疗以及行为治疗与药物联合治疗。
我们从支付方的角度衡量成本，评估了这些替代疗法的成本效益。首选的成本效益治疗方法因儿童的共病情况以及政策制定者的支付意愿而异。对于单纯（无共病）的ADHD，高质量的药物管理在所有支付意愿水平下似乎都具有成本效益。相比之下，对于某些共病情况，支付意愿至关重要：支付意愿低的政策制定者可能会认为药物管理最具成本效益。另一方面，愿意为未来节省成本（例如涉及青少年司法）而现在支付更多的政策制定者会认识到，对于共病情况，最具成本效益的选择可能涉及行为疗法，无论是否用药。
对ADHD治疗成本和效果的分析必须考虑共病的作用。
