THE COST-EFFECTIVENESS OF TREATMENTS FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) IN CHILDREN AGES 7-10

Purpose: Assess the cost-effectiveness of treatment strategies for Attention Deficit Hyperactivity Disorder (ADHD) in children ages 7-10 years.

Methods: Based on the Multimodal Treatment of ADHD (MTA) clinical trial, this analysis computes the incremental costs (in $2006) and effectiveness (in quality-adjusted life years, QALYs) using standard methods for community care, behavioral treatment, managed medication, and the combination of managed medication and behavioral treatments. This analysis takes a societal perspective, uses the MTA intervention cost estimates, and adds consideration of parental time costs. The analysis characterizes health utility weights as a function of ADHD health effects using a linear regression of survey data collected from a convenience sample of 113 families of children similar to those originally included in the MTA . The cost-effectiveness model predicts QALY and cost estimates at intervals of 0, 3, 9 and 14 months from the beginning of treatment, and numerous sensitivity analyses provide insights about robustness and limitations of the existing data.

Results: Managed medication appears highly cost-effective compared to community care (incremental cost-effectiveness ratio of $6,530/QALY). In contrast, combination treatment does not appear cost-effective by current standards ($753,761/QALY), even when considered only the patients with multiple comorbid illnesses in addition to ADHD ($729,174/ QALY). All strategies dominate behavioral management alone, which implies that ADHD patients benefit from medication, with management of medication emerging as particularly important and still cost effective with if medication costs doubled. Adding behavioral treatments to managed medication appears to provide only a relatively small incremental benefit compared with managed medication, and given the high costs the addition does not appear cost-effective.

Conclusions: Children and their families appear to benefit significantly from ADHD medications and ADHD medications appear to represent a cost-effective societal intervention. Carefully managed medication that involves a physician closely monitoring and adjusting titers of ADHD medications as needed represents a highly cost-effective intervention in addition to medication alone. Insurance typically reimburses physicians for office time, but not time spent on monitoring medications through phone calls to parents and teachers, which suggests that payment for such monitoring may cost-effectively improve clinical results.