Freriks Roel D, Mierau Jochen O, van der Schans Jurjen, Groenman Annabeth P, Hoekstra Pieter J, Postma Maarten J, Buskens Erik, Cao Qi
Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands.
Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
MDM Policy Pract. 2019 Aug 17;4(2):2381468319867629. doi: 10.1177/2381468319867629. eCollection 2019 Jul-Dec.
This study aimed to assess the cost-effectiveness of treatments for attention-deficit/hyperactivity disorder (ADHD) in children through prevention of serious delinquent behavior. Cost-effectiveness was assessed in net-monetary benefit (NMB). To evaluate the three major forms of ADHD treatment (medication management, behavioral treatment, and the combination thereof) relative to community-delivered treatment (control condition), we used data from 448 children, aged 7 to 10, who participated in the National Institute of Mental Health's Multimodal Treatment Study of Children with ADHD. We developed a three-state continuous-time Markov model (no delinquency, minor to moderate delinquency, serious delinquency) to extrapolate the results 10 years beyond the 14-month trial period at a 3% discount rate. Serious delinquency was considered an absorbing state to enable assessment in life-years (LYs) of serious delinquent behavior prevented. The willingness-to-pay (WTP) threshold was set equal to the annual cost associated with serious delinquency in children with ADHD of $12,370. Modeled and observed outcomes matched closely with a mean difference of 6.9% in LYs of serious delinquent behavior prevented. The economic evaluation revealed a NMB of $95,449, $88,553, $90,536 and $98,660 for medication management, behavioral treatment, combined treatment, and routine community care, respectively. Estimates remained stable after linearly increasing the WTP threshold between $0 and $50,000 in the deterministic sensitivity analyses. This study assessed the cost-effectiveness of treatments for ADHD in children using continuous-time Markov modeling. We show that treatment evaluation in broader societal outcomes is essential for policy makers, as the three major forms of ADHD treatment turned out to be inferior to the control condition.
本研究旨在通过预防严重犯罪行为来评估儿童注意力缺陷多动障碍（ADHD）治疗方法的成本效益。成本效益通过净货币效益（NMB）进行评估。为了评估ADHD治疗的三种主要形式（药物管理、行为治疗及其组合）相对于社区提供的治疗（对照条件）的效果，我们使用了来自448名7至10岁儿童的数据，这些儿童参与了美国国立精神卫生研究所的ADHD儿童多模式治疗研究。我们开发了一个三状态连续时间马尔可夫模型（无犯罪、轻度至中度犯罪、严重犯罪），以3%的贴现率将结果外推至14个月试验期后的10年。严重犯罪被视为吸收状态，以便能够以预防严重犯罪行为的生命年（LYs）进行评估。支付意愿（WTP）阈值设定为等于ADHD儿童严重犯罪相关的年度成本12,370美元。建模结果与观察结果紧密匹配，预防严重犯罪行为的生命年平均差异为6.9%。经济评估显示，药物管理、行为治疗、联合治疗和常规社区护理的净货币效益分别为95,449美元、88,553美元、90,536美元和98,660美元。在确定性敏感性分析中，将WTP阈值在0美元至50,000美元之间线性增加后，估计值保持稳定。本研究使用连续时间马尔可夫模型评估了儿童ADHD治疗方法的成本效益。我们表明，对政策制定者来说，在更广泛的社会结果中进行治疗评估至关重要，因为ADHD治疗的三种主要形式结果证明不如对照条件。
