Pharmacotherapies for attention-deficit/hyperactivity disorder: Expected-cost analysis

Background. Attention-deficit/hyperactivity disorder (ADHD) is a common chi ldhood neurobehavioral disorder characterized by inattention, hyperactivity , and impulsivity. Prevalence estimates in elementary school children gener ally range from 3% to 8%. ADHD is frequently treated with psychostimulant m edications, which have been shown to improve both cognitive and behavioral outcomes for most children. Objective: The goal of this study was to estimate the total expected costs for the treatment and management of school-age children with ADHD using 6 c ommonly prescribed pharmacotherapies: methylphenidate immediate-release/ext ended-release (MPH IR/ER). methylphenidate immediate-release (MPH IR), Meta date((R)) CD (branded MPH IR/ER). Concerta (TM) (branded MPH ER), Ritalin(( R)) (branded MPH IR). and Adderall((R)) (a combination of dextroamphetamine and amphetamine salts). Methods: A literature review and clinical assessment using a 27-question su rvey instrument were used to capture information on the clinical characteri stics of ADHD, including common treatment regimens. clinical management of patients, pathways of care, and components of care. A meta-analysis provide d response rates for 3 commonly used pharmacotherapies: Metadate CD. MPH IR . and Adderall. Information from the clinical assessment and the meta-analy sis were used to populate a decision-analytic model to compute total expect ed cost for each comparator. Results: The average total annual expected cost per patient was $1487 for M etadate CD, $1631 for Concerta, $1792 for MPH IR/ER. $1845 for MPH IR, $208 0 for Ritalin, and $2232 for Adderall. Conclusions: Metadate CD had the lowest total expected cost and Adderall ha d the highest total expected cost among the ADHD pharmacotherapies evaluate d. The differences were attributable to differences in drug-acquisition cos ts and the need for in-school dosing of twice-daily and thrice-daily medica tions.