Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden.
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Eur Child Adolesc Psychiatry. 2022 Nov;31(11):1655-1670. doi: 10.1007/s00787-021-01748-z. Epub 2021 Mar 9.
Economic evaluations can help decision makers identify what services for children with neurodevelopmental disorders provide best value-for-money. The aim of this paper is to review the best available economic evidence to support decision making for attention deficit-hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children and adolescents. We conducted a systematic review of economic evaluations of ADHD and ASD interventions including studies published 2010-2020, identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and consequences were included. The quality of the studies was assessed using the Drummond checklist. We identified ten studies of moderate-to-good quality on the cost-effectiveness of treatments for ADHD and two studies of good quality of interventions for ASD. The majority of ADHD studies evaluated pharmacotherapy (n = 8), and two investigated the economic value of psychosocial/behavioral interventions. Both economic evaluations for ASD investigated early and communication interventions. Included studies support the cost-effectiveness of behavioral parenting interventions for younger children with ADHD. Among pharmacotherapies for ADHD, different combinations of stimulant/non-stimulant medications for children were cost-effective at willingness-to-pay thresholds reported in the original papers. Early intervention for children with suspected ASD was cost-effective, but communication-focused therapy for preschool children with ASD was not. Prioritizing more studies in this area would allow decision makers to promote cost-effective and clinically effective interventions for this target group.
经济评估可以帮助决策者确定哪些针对神经发育障碍儿童的服务具有最佳的性价比。本文旨在综述目前有关儿童注意缺陷多动障碍（ADHD）和自闭症谱系障碍（ASD）的最佳经济证据，以支持相关决策。我们对 ADHD 和 ASD 干预措施的经济评估进行了系统综述，包括 2010 年至 2020 年发表的研究，通过 Econlit、Medline、PsychINFO 和 ERIC 数据库进行了检索。仅纳入了比较两种或多种方案、同时考虑成本和结果的全经济评估。使用 Drummond 清单评估研究质量。我们确定了 10 项关于 ADHD 治疗成本效益的高质量研究和 2 项关于 ASD 干预措施的高质量研究。大多数 ADHD 研究评估了药物治疗（n=8），两项研究评估了心理社会/行为干预的经济价值。两项针对 ASD 的经济评估均研究了早期干预和沟通干预。纳入的研究支持针对 ADHD 年幼儿童的行为养育干预具有成本效益。在 ADHD 的药物治疗中，对于符合原始论文中报告的意愿支付阈值的儿童，不同的兴奋剂/非兴奋剂药物联合治疗具有成本效益。针对疑似 ASD 儿童的早期干预具有成本效益，但针对学龄前 ASD 儿童的以沟通为重点的治疗则不然。优先在该领域开展更多研究将使决策者能够为该目标群体推广具有成本效益和临床疗效的干预措施。
