Cost-effectiveness of dexamphetamine and methylphenidate for the treatment of childhood attention deficit hyperactivity disorder

Donnelly, Marie, Haby, Michelle M., Carter, Rob, Andrews, Gavin and Vos, Theo 2004, Cost-effectiveness of dexamphetamine and methylphenidate for the treatment of childhood attention deficit hyperactivity disorder, Australian & New Zealand journal of psychiatry, vol. 38, pp. 592-601.

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Title Cost-effectiveness of dexamphetamine and methylphenidate for the treatment of childhood attention deficit hyperactivity disorder
Author(s) Donnelly, Marie
Haby, Michelle M.
Carter, Rob
Andrews, Gavin
Vos, Theo
Journal name Australian & New Zealand journal of psychiatry
Volume number 38
Start page 592
End page 601
Publisher Taylor and Francis Ltd
Place of publication Abingdon, England
Publication date 2004-08-05
ISSN 0004-8674
1440-1614
Keyword(s) attention deficit hyperactivity disorder
meta-analysis
methylphenidate
dexamphetamine
cost effectiveness;
Summary Objective: To analyze from a health sector perspective the cost-effectiveness of dexamphetamine (DEX) and methylphenidate (MPH) interventions to treat childhood attention deficit hyperactivity disorder (ADHD), compared to current practice.

Method: Children eligible for the interventions are those aged between 4 and 17 years in 2000, who had ADHD and were seeking care for emotional or behavioural problems, but were not receiving stimulant medication. To determine health benefit, a meta-analysis of randomized controlled trials was performed for DEX and MPH, and the effect sizes were translated into utility values. An assessment on second stage filter criteria ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Simulation modelling techniques are used to present a 95% uncertainty interval (UI) around the incremental costeffectiveness ratio (ICER), which is calculated in cost (in A$) per DALY averted.

Results:
The ICER for DEX is A$4100/DALY saved (95% UI: negative to A$14 000) and for MPH is A$15 000/DALY saved (95% UI: A$9100-22 000). DEX is more costly than MPH for the government, but much less costly for the patient.

Conclusions:
MPH and DEX are cost-effective interventions for childhood ADHD. DEX is more cost-effective than MPH, although if MPH were listed at a lower price on the Pharmaceutical Benefits Scheme it would become more cost-effective. Increased uptake of stimulants for ADHD would require policy change. However, the medication of children and wider availability of stimulants may concern parents and the community.
Language eng
Field of Research 111714 Mental Health
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2004, Taylor & Francis Ltd.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30009392

Document type: Journal Article
Collection: School of Health and Social Development
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