A Cost-Utility Analysis of Lisdexamfetamine Versus Atomoxetine in the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Inadequate Response to Methylphenidate

Autor: Paul Hodgkins, Juliana Setyawan, Matthias Bischof, Josephine Mauskopf, Evelina Zimovetz, Stephen Beard
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Pediatrics
Adolescent
Cost effectiveness
Cost-Benefit Analysis
Clinical Neurology
Atomoxetine Hydrochloride
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Humans
Medicine
Attention deficit hyperactivity disorder
Pharmacology (medical)
Original Research Article
030212 general & internal medicine
Lisdexamfetamine Dimesylate
Child
Psychiatry
Probability
business.industry
Methylphenidate
Atomoxetine
medicine.disease
Quality-adjusted life year
Psychiatry and Mental health
Treatment Outcome
Lisdexamfetamine
Tolerability
Attention Deficit Disorder with Hyperactivity
Health Resources
Central Nervous System Stimulants
Female
Quality-Adjusted Life Years
Neurology (clinical)
business
030217 neurology & neurosurgery
medicine.drug
Zdroj: CNS Drugs
ISSN: 1179-1934
1172-7047
DOI: 10.1007/s40263-016-0354-3
Popis: Background An economic analysis from the perspective of the UK National Health Service (NHS) evaluated the cost effectiveness of lisdexamfetamine dimesylate (LDX) compared with atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder who have had an inadequate response to methylphenidate. Methods A 1-year decision-analytic model was constructed, with the health outcomes “response”, “nonresponse”, and “unable to tolerate”. Clinical data were taken from a head-to-head, randomized controlled trial in inadequate responders to methylphenidate. Response to treatment was defined as a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impression–Improvement subscale. Tolerability was assessed by discontinuation rates owing to adverse events. Utility weights were identified via a systematic literature review. Healthcare resource use estimates were obtained via a survey of clinicians. Daily drug costs were derived from British National Formulary 2012 costs and mean doses reported in the trial. One-way and probabilistic sensitivity analyses (PSAs) were performed. Results The comparison of LDX with atomoxetine resulted in an estimate of an incremental cost-effectiveness ratio of £1802 per quality-adjusted life-year (QALY). The result was robust in a wide range of sensitivity analyses; results were most sensitive to changes in drug costs and efficacy. In the PSA, assuming a maximum willingness to pay of £20,000 per QALY, LDX versus atomoxetine had an 86 % probability of being cost effective. In 38 % of PSA runs, LDX was more effective and less costly than atomoxetine. Conclusions From the perspective of the UK NHS, LDX provides a cost-effective treatment option for children and adolescents who are inadequate responders to methylphenidate. Electronic supplementary material The online version of this article (doi:10.1007/s40263-016-0354-3) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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