van der Kolk Annemarie, Bouwmans Clazien Am, Schawo Saskia J, Buitelaar Jan K, van Agthoven Michel, Hakkaart-van Roijen Leona
Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, the Netherlands ; Janssen-Cilag BV, P.O. Box 90240, 5000 LT Tilburg, the Netherlands.
Institute for Medical Technology Assessment (iMTA), P.O. Box 1738, 3000, DR Rotterdam, the Netherlands.
Springerplus. 2015 May 15;4:224. doi: 10.1186/s40064-015-0978-7. eCollection 2015.
Attention Deficit Hyperactivity Disorder (ADHD) is associated with considerable burden of illness at a patient, family and societal level. Although pharmacological treatment is recommended by authoritative guidelines, evidence on its influence on the broader burden of illness is limited. As treatment induces costs, proper healthcare decision making requires evidence on the associated societal costs or benefits and particularly the difference that response to treatment can make. Data on ADHD related resource use of patients 8-18 years and parents were collected by means of a cross-sectional, online survey amongst members of the Dutch parent association. Children were stratified to responders and non-responders to treatment according to pre-defined expert definitions. Analyses were performed on 618 questionnaires (428 responders; 190 non-responders to treatment). Children were 11.8 years on average and mainly boys (82 %). Total monthly costs for children were €578 and €839 for responders and non-responders, respectively (p = 0.021), with a breakdown to direct medical costs (€322 vs. €512; p = 0.068), direct non-medical costs (€222 vs. €296; p = 0.090), and indirect non-medical costs (€34 vs. €57; p < 0.001). For parents, total costs were €246 vs. €399 for the responding and non-responding children, respectively (p = 0.006), with a breakdown to direct medical costs (€130 vs. €211; p = 0.010) and indirect non-medical costs (€116 vs. €181; p = 0.092). Total monthly costs of children and their parents together were €824 and €1228 for responders and non-responders to treatment, respectively (p = 0.002). These results stress the importance of a focus on response to treatment, not only beneficial for patients and their family, but also resulting in considerable societal benefits.
注意缺陷多动障碍（ADHD）在患者、家庭和社会层面都带来了相当大的疾病负担。尽管权威指南推荐药物治疗，但其对更广泛疾病负担影响的证据有限。由于治疗会产生成本，恰当的医疗决策需要关于相关社会成本或效益的证据，特别是治疗反应所能带来的差异。通过对荷兰家长协会成员进行横断面在线调查，收集了8至18岁患者及其父母与ADHD相关的资源使用数据。根据预先定义的专家定义，将儿童分为治疗反应者和非反应者。对618份问卷（428名反应者；190名治疗非反应者）进行了分析。儿童平均年龄为11.8岁，主要为男孩（82%）。反应者和非反应者儿童的每月总费用分别为578欧元和839欧元（p = 0.021），细分为直接医疗费用（322欧元对512欧元；p = 0.068）、直接非医疗费用（222欧元对296欧元；p = 0.090）和间接非医疗费用（34欧元对57欧元；p < 0.001）。对于父母来说，反应者和非反应者儿童的总费用分别为246欧元和399欧元（p = 0.006），细分为直接医疗费用（130欧元对211欧元；p = 0.010）和间接非医疗费用（116欧元对181欧元；p = 0.092）。治疗反应者和非反应者儿童及其父母的每月总费用分别为824欧元和1228欧元（p = 0.002）。这些结果强调了关注治疗反应的重要性，这不仅对患者及其家庭有益，也会带来可观的社会效益。
