Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

• Published in: Revista brasileira de psiquiatria 2016-03, Vol.38 (1), p.30-38
• Main Authors: Maia, Carlos R, Stella, Steffan F, Wagner, Flavia, Pianca, Thiago G, Krieger, Fernanda V, Cruz, Luciane N, Polanczyk, Guilherme V, Rohde, Luís A, Polanczyk, Carísi A
• Format: Article
• Language: English
• Subjects: Adolescent; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - economics; Attention deficit hyperactivity disorder; Brazil; Central Nervous System Stimulants - economics; Central Nervous System Stimulants - therapeutic use; Child; Cost-Benefit Analysis; cost-utility analysis; Delayed-Action Preparations - administration & dosage; Delayed-Action Preparations - economics; Drug Costs - statistics & numerical data; Female; Follow-Up Studies; Humans; Male; Markov Chains; methylphenidate; Methylphenidate - economics; Methylphenidate - therapeutic use; Original; PSYCHIATRY; Quality-Adjusted Life Years; Sensitivity and Specificity
• ISSN: 1516-4446; 1809-452X; 1809-452X
• DOI: 10.1590/1516-4446-2014-1516

To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. NCT01705613.