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Probabilistic Markov Model Estimating Cost Effectiveness of Methylphenidate Osmotic-Release Oral System Versus Immediate-Release Methylphenidate in Children and Adolescents: Which Information is Needed?

Schawo, S., van der Kolk, A., Bouwmans, C., Annemans, L., Postma, M., Buitelaar, J., van Agthoven, M. & Hakkaart-van Roijen, L., May-2015, In : Pharmacoeconomics. 33, 5, p. 489–509 21 p.

Research output: Contribution to journalArticleAcademicpeer-review

  • Saskia Schawo
  • Annemarie van der Kolk
  • Clazien Bouwmans
  • Lieven Annemans
  • Maarten Postma
  • Jan Buitelaar
  • Michel van Agthoven
  • Leona Hakkaart-van Roijen

BACKGROUND: Incidence of attention deficit hyperactivity disorder (ADHD) in children and adolescents has been increasing. The disorder results in high societal costs. Policymakers increasingly use health economic evaluations to inform decisions on competing treatments of ADHD. Yet, health economic evaluations of first-choice medication of ADHD in children and adolescents are scarce and generally do not include broader societal effects.

OBJECTIVES: This study presents a probabilistic model and analysis of methylphenidate osmotic-release oral system (OROS) versus methylphenidate immediate-release (IR). We investigate and include relevant societal aspects in the analysis so as to provide cost-effectiveness estimates based on a broad societal perspective.

METHODS: We enhanced an existing Markov model and determined the cost effectiveness of OROS versus IR for children and adolescents responding suboptimally to treatment with IR. Enhancements included screening of a broad literature base, updated utility values, inclusion of costs and effects on caregivers and a change of the model type from deterministic to probabilistic.

RESULTS: The base case scenario resulted in lower incremental costs (<euro>-5815) of OROS compared with IR and higher incremental quality-adjusted life-year (QALY) gains (0.22). Scenario analyses were performed to determine sensitivity to changes in transition rates, utility of caregivers, medical costs of caregivers and daily medication dose.

CONCLUSIONS: The results indicate that, for children responding suboptimally to treatment with IR, the beneficial effect of OROS on compliance may be worth the additional costs of medication. The presented model adds to the health economic information available for policymakers and to considerations on a broader perspective in cost-effectiveness analyses.

Original languageEnglish
Pages (from-to)489–509
Number of pages21
JournalPharmacoeconomics
Volume33
Issue number5
Publication statusPublished - May-2015

    Keywords

  • adolescent, attention deficit disorder, caregiver, child, cost effectiveness analysis, diseases, drug therapy, economic evaluation, health, human, model, quality adjusted life year, screening, methylphenidate

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