Herescon GmbH, Health Economic Research & Consulting, Hannover, Germany.
Clin Ther. 2013 May;35(5):673-85. doi: 10.1016/j.clinthera.2013.03.017. Epub 2013 Apr 13.
Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous behavioral disorder commonly found in children, with serious lifetime health and social consequences for both children and their parents. Public awareness of ADHD in Germany has increased in the past decade, but little is known about the costs of treating newly diagnosed patients in clinical practice.
This study aimed to describe the resource utilization and treatment costs of patients aged 6 to 17 years with newly diagnosed ADHD, using patient data from a German sickness fund, and to quantify resource utilization by drug treatment and treatment persistence.
To identify patients with newly diagnosed ADHD, the second largest German sickness fund was utilized. Complete claims data of all de-identified patients meeting eligibility criteria for 2007 and 2008 were extracted. Patients were divided into 1 of 3 treatment groups: drug treatment-persistent, drug treatment-nonpersistent, and nondrug treatment. The differences in costs and resource utilization are reported in a descriptive manner, with paired and unpaired 2-sample Wilcoxon tests used.
Of 3407 newly diagnosed patients with ADHD, 1105 (32%) received an ADHD-specific drug following diagnosis; the remaining 2302 comprised the nondrug treatment group. Of the total number of drug-treated patients, 1-year observational data were available for only 786 methylphenidate users (71%). Of these, 503 patients (64%) comprised the drug treatment-persistent group (those having at least 1 prescription every 3 months during the 12 months following their first ADHD prescription) and 283 (36%) comprised the drug treatment-nonpersistent group. After excluding those patients with <12 months of follow-up, 1779 patients (52%) were included in the nondrug-treatment group. Outpatient visits and the number of drug prescriptions and associated costs were highest in the drug treatment-persistent group (P = 0.05); however, the number of hospital admissions and days spent in-hospital were lowest in this group. Significant average savings of €347/y in overall costs(P ¼ 0.05) were noted for the drug treatment–persistent group compared with the drug treatment–non persistent group. Nondrug-treated patients had €181/y lower costs (P ¼ 0.05) comparedtodrugtreatment-persistentgroup.Drugtreatment-nonpersistentpatientswerethemost expensive group [corrected]. These mean savings were €739/y and €552/y (drug treatment-persistent group and drug treatment-nonpersistent group, respectively) compared with nondrug-treated patients.
There are potential cost-savings benefits when patients are treatment persistent compared to nonpersistent [corrected]. Therefore, future disease-management programs might consider treatment persistence as potentially reducing overall payer costs. Additionally, the clinical and psychosocial situations of patients and their families should be taken into account.
注意缺陷多动障碍（ADHD）是一种常见于儿童的异质性行为障碍，对儿童及其父母的终生健康和社会都有严重影响。在过去的十年中，德国公众对 ADHD 的认识有所提高，但对于在临床实践中治疗新诊断患者的成本知之甚少。
本研究旨在描述新诊断为 ADHD 的 6 至 17 岁患者的资源利用情况和治疗费用，使用德国一家医疗保险的数据，并通过药物治疗和治疗持续性来量化资源利用情况。
利用德国第二大医疗保险，确定新诊断为 ADHD 的患者。提取符合 2007 年和 2008 年入选标准的所有患者的完整匿名数据。患者被分为 3 个治疗组之一：药物治疗持续组、药物治疗非持续组和非药物治疗组。以描述性方式报告成本和资源利用的差异，使用配对和非配对 2 样本 Wilcoxon 检验。
在 3407 名新诊断为 ADHD 的患者中，有 1105 名（32%）在诊断后接受了 ADHD 特异性药物治疗；其余 2302 名患者为非药物治疗组。在接受药物治疗的患者中，只有 786 名（71%）的患者有 1 年的观察性数据。其中，503 名患者（64%）为药物治疗持续组（即首次 ADHD 处方后 12 个月内至少有 1 次处方），283 名患者（36%）为药物治疗非持续组。排除随访时间<12 个月的患者后，有 1779 名患者（52%）纳入非药物治疗组。药物治疗持续组的门诊就诊次数和药物处方数量及相关费用最高（P = 0.05）；然而，该组住院人数和住院天数最少。与药物治疗非持续组相比，药物治疗持续组的总体成本平均节省 347 欧元/年（P = 0.05）。与药物治疗持续组相比，非药物治疗组的成本降低了 181 欧元/年（P = 0.05）。药物治疗非持续组的费用最高。与非药物治疗组相比，药物治疗持续组和药物治疗非持续组分别节省 739 欧元/年和 552 欧元/年。
与非持续性治疗相比，患者的治疗持续性存在潜在的成本节约效益。因此，未来的疾病管理项目可能会考虑治疗持续性，以潜在地降低总体支付者成本。此外，还应考虑患者及其家庭的临床和社会心理情况。
