Faber Adrianne, van Agthoven Michel, Kalverdijk Luuk J, Tobi Hilde, de Jong-van den Berg Lolkje T W, Annemans Lieven, Postma Maarten J
Groningen University Institute for Drug Exploration, University of Groningen, Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen, The Netherlands.
CNS Drugs. 2008;22(2):157-70. doi: 10.2165/00023210-200822020-00006.
Attention-deficit hyperactivity disorder (ADHD) is the most common mental health disorder in youths. Stimulants are the drugs of first choice in the treatment of ADHD. It has been suggested that full costs associated with the treatment of ADHD may be reduced by once-daily administration regimens of stimulants.
To estimate the cost effectiveness of treatment with long-acting methylphenidate osmotic release oral system (OROS) [Concerta] for youths with ADHD for whom treatment with immediate-release (IR) methylphenidate is suboptimal.
We developed a Markov model to obtain an incremental cost-effectiveness ratio (ICER). The analysis covered 10 years, with a Markov cycle of 1 day. Costs (in 2005 euros ) included medication, consultations and treatment interventions, and additional costs for attending special education. Quality-adjusted life-years (QALYs) were used as the effectiveness measure. Outcome probabilities were taken from the medical literature and an expert panel of five child psychiatrists and paediatricians. Univariate sensitivity analyses were performed to assess the robustness of the base-case estimate. Multivariate sensitivity analysis was used to estimate a worst- and best-case ICER.
The ICER of methylphenidate-OROS treatment in youths with ADHD for whom treatment with IR methylphenidate is suboptimal was euro 2004 per QALY. Total costs after 10 years were euro 15,739 for the IR methylphenidate pathway and euro 16,015 for the methylphenidate-OROS pathway. In the univariate sensitivity analysis, the ICER was sensitive to changes in resource use and the probability of stopping stimulant treatment in favour of IR methylphenidate. An ICER of 0 was reached with a 6.2% price reduction of methylphenidate-OROS.
Methylphenidate-OROS is a cost-effective treatment for youths with ADHD for whom treatment with IR methylphenidate is suboptimal. Higher medication costs of methylphenidate-OROS were compensated for by savings on resource use, yielding similar 10-year costs compared with treatment with IR methylphenidate. Our analysis is sensitive to both clinical parameters and (differences in) resource utilization and costs between the groups modelled, warranting further research within clinical trials and observational databases, and into the full scope of costs.
注意力缺陷多动障碍（ADHD）是青少年中最常见的心理健康障碍。兴奋剂是治疗ADHD的首选药物。有人提出，通过兴奋剂每日一次给药方案，可降低ADHD治疗的全部成本。
评估长效哌甲酯渗透泵控释口服系统（OROS）[康奈达]治疗ADHD青少年的成本效益，这些青少年使用速释（IR）哌甲酯治疗效果欠佳。
我们开发了一个马尔可夫模型以获得增量成本效益比（ICER）。分析涵盖10年，马尔可夫周期为1天。成本（以2005年欧元计）包括药物、咨询和治疗干预，以及参加特殊教育的额外成本。质量调整生命年（QALYs）用作效果指标。结果概率取自医学文献以及由五位儿童精神科医生和儿科医生组成的专家小组。进行单因素敏感性分析以评估基础病例估计的稳健性。多因素敏感性分析用于估计最坏和最好情况下的ICER。
对于使用IR哌甲酯治疗效果欠佳的ADHD青少年，哌甲酯OROS治疗的ICER为每QALY 2004欧元。10年后，IR哌甲酯治疗途径的总成本为15,739欧元，哌甲酯OROS治疗途径的总成本为16,015欧元。在单因素敏感性分析中，ICER对资源使用变化以及停止使用兴奋剂转而使用IR哌甲酯治疗的概率敏感。哌甲酯OROS价格降低6.2%时，ICER为0。
对于使用IR哌甲酯治疗效果欠佳的ADHD青少年，哌甲酯OROS是一种具有成本效益的治疗方法。哌甲酯OROS较高的药物成本因资源使用节省而得到补偿，与IR哌甲酯治疗相比，10年成本相似。我们的分析对临床参数以及所建模组之间的资源利用和成本（差异）均敏感，需要在临床试验和观察性数据库中进一步研究，并研究全部成本范围。
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