Institute for Innovation & Valuation in Health Care (INNOVALHC), Eschborn, Germany.
Child Adolesc Psychiatry Ment Health. 2007 Nov 15;1(1):13. doi: 10.1186/1753-2000-1-13.
During the last decade, pharmaceutical spending for patients with attention-deficit-hyperactivity disorder (ADHD) has been escalating internationally.
First, to estimate future trends of ADHD-related drug expenditures from the perspectives of the statutory health insurance (SHI; Gesetzliche Krankenversicherung, GKV) in Germany and the National Health Service (NHS) in England, respectively, for children and adolescents age 6 to 18 years. Second, to evaluate the budgetary impact on individual prescribers (child and adolescent psychiatrists and pediatricians treating patients with ADHD) in Germany.
A model was developed to predict plausible scenarios of future pharmaceutical expenditures for treatment of ADHD. Model inputs were derived from demographic and epidemiological data, a literature review of past spending trends, and an analysis of new pharmaceutical products in development for ADHD. Only products in clinical development phase III or later were considered. Uncertainty was addressed by way of scenario analysis. For each jurisdiction, five scenarios used different assumptions of future diagnosis prevalence, treatment prevalence, rates of adoption and unit costs of novel drugs, and treatment intensity.
Annual ADHD pharmacotherapy expenditures for children and adolescents will further increase and may exceed euro 310 m (D; E: 78 m) in 2012 (2002: approximately euro 21.8 m; approximately 7.0 m). During this period, overall drug spending by individual physicians may increase 2.3- to 9.5-fold, resulting from the multiplicative effects of four variables: increased number of diagnosed cases, growing acceptance and intensity of pharmacotherapy, and higher unit costs of novel medications.
Even for an extreme low case scenario, a more than six-fold increase of pharmaceutical spending for children and adolescents is predicted over the decade from 2002 to 2012, from the perspectives of both the NHS in England and the GKV in Germany. This budgetary impact projection represents a partial analysis only because other expenditures are likely to rise as well, for instance those associated with physician services, including diagnosis and psychosocial treatment. Further to this, by definition budgetary impact analyses have little to nothing to say about clinical appropriateness and about value of money.
Providers of care for children and adolescents with ADHD should anticipate serious challenges related to the cost-effectiveness of interventions.
在过去的十年中，国际上针对注意力缺陷多动障碍（ADHD）患者的药品支出一直在不断增加。
首先，分别从德国法定健康保险（SHI；Gesetzliche Krankenversicherung，GKV）和英国国家卫生服务（NHS）的角度估计 6 至 18 岁儿童和青少年的 ADHD 相关药物支出的未来趋势。其次，评估德国个别处方者（治疗 ADHD 患者的儿童和青少年精神病医生和儿科医生）的预算影响。
开发了一个模型来预测未来用于治疗 ADHD 的药品支出的合理方案。模型的输入源自人口统计学和流行病学数据、对过去支出趋势的文献综述以及对正在开发的用于 ADHD 的新药物的分析。仅考虑处于临床开发 III 期或更后期的产品。通过情景分析来解决不确定性。对于每个管辖区，五个方案使用不同的未来诊断患病率、治疗患病率、采用率和新型药物单位成本以及治疗强度的假设。
儿童和青少年的年度 ADHD 药物治疗支出将进一步增加，到 2012 年可能超过 3.1 亿欧元（德国：7800 万欧元）（2002 年：约 2180 万欧元；约 700 万欧元）。在此期间，由于四个变量的倍增效应，个体医生的整体药物支出可能会增加 2.3 至 9.5 倍：诊断病例数量的增加、药物治疗的接受度和强度的增加以及新型药物的单位成本的增加。
即使是从英国 NHS 和德国 GKV 的角度来看，在 2002 年至 2012 年的十年间，预计儿童和青少年的药品支出也将增长六倍以上。这一预算影响预测仅代表部分分析，因为其他支出也可能增加，例如与医生服务相关的支出，包括诊断和心理社会治疗。除此之外，根据定义，预算影响分析几乎没有涉及临床适当性和货币价值。
为患有 ADHD 的儿童和青少年提供护理的提供者应预期与干预措施的成本效益相关的严重挑战。
