Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2009

Open Access 01-12-2009 | Research article

A modelled economic evaluation comparing atomoxetine with methylphenidate in the treatment of children with attention-deficit/hyperactivity disorder in Spain

Authors: Jihyung Hong, Tatiana Dilla, Jorge Arellano

Published in: BMC Psychiatry | Issue 1/2009

Login to get access

Abstract

Background

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurobehavioural disorder, affecting 3–6% of school age children and adolescents in Spain. Methylphenidate (MPH), a mild stimulant, had long been the only approved medication available for ADHD children in Spain. Atomoxetine is a non-stimulant alternative in the treatment of ADHD with once-a-day oral dosing. This study aims to estimate the cost-effectiveness of atomoxetine compared to MPH. In addition, atomoxetine is compared to 'no medication' for patient populations who are ineligible for MPH (i.e. having stimulant-failure experience or co-morbidities precluding stimulant medication).

Methods

An economic model with Markov processes was developed to estimate the costs and benefits of atomoxetine versus either MPH or 'no medication'. The incremental cost per quality-adjusted life-year (QALY) was calculated for atomoxetine relative to the comparators. The Markov process incorporated 14 health states, representing a range of outcomes associated with treatment options. Utility values were obtained from the utility valuation survey of 83 parents of children with ADHD. The clinical data were based on a thorough review of controlled clinical trials and other clinical literature, and validated by international experts. Costs and outcomes were estimated using Monte Carlo simulation over a 1-year duration, with costs estimated from the perspective of the National Health Service in Spain.

Results

For stimulant-naïve patients without contra-indications to stimulants, the incremental costs per QALY gained for atomoxetine were € 34 308 (compared to an immediate-release MPH) and € 24 310 (compared to an extended-release MPH). For those patients who have stimulant-failure experience or contra-indications to stimulants, the incremental costs per QALY gained of atomoxetine compared to 'no medication' were € 23 820 and € 23 323, respectively.

Conclusion

The economic evaluation showed that atomoxetine is an effective alternative across a range of ADHD populations and offers value-for money in the treatment of ADHD.
Appendix
Available only for authorised users
Literature
1.
Faraone SV, Sergeant J, Gillberg C, Biederman J: The worldwide prevalence of ADHD: is it an American condition?. World Psychiatry. 2003, 2 (2): 104-113.PubMedPubMedCentral
2.
Jensen PS, Garcia JA, Glied S, Crowe M, Foster M, Schlander M, Hinshaw S, Vitiello B, Arnold LE, Elliott G, et al: Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD. Am J Psychiatry. 2005, 162 (9): 1628-1636. 10.1176/appi.ajp.162.9.1628.CrossRefPubMed
3.
Biederman J: Attention-deficit/hyperactivity disorder: a life-span perspective. J Clin Psychiatry. 1998, 59 (Suppl 7): 4-16.PubMed
4.
Biederman J, Mick E, Farone SV: Age-dependent decline of symptoms of attention-deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000, 157: 816-818. 10.1176/appi.ajp.157.5.816.CrossRefPubMed
5.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 2000, Washington, DC: American Psychiatric Press, 4
6.
Kratochvil CJ, Newcorn JH, Arnold E, Duesenberg D, Emslie G, Quintana H, E H, Wagner KD, Gao H, Michelson D, Biederman J: Atomoxetine Alone or Combined With Fluoxetine for Treating ADHD With Comorbid Depressive or Anxiety Symptoms. J AM Acad Adolesc Psychiatry. 2005, 44 (9): 915-924. 10.1097/01.chi.0000169012.81536.38.CrossRef
7.
Banaschewski T, Roessner V, Dittmann RW, Santosh P, Rothenberger A: Non-stimulant medications in the treatment of ADHD. Eur Child Adolesc Psychiatry. 2004, 13 Suppl 1: I102-I116.PubMed
8.
Downey KK, Stelson FW, Pomerleau OF, Giodani B: Adult attention deficit hyperactivity disorder: psychological test profiles in a clinical population. J Nerv Ment Dis. 1997, 185: 32-38. 10.1097/00005053-199701000-00006.CrossRefPubMed
9.
Barkley RA, Guevremont DC, Anastopoulos AD, DuPaul GJ, Shelton TL: Driving-related risks and outcomes of attention deficit hyperactivity disorder in adolescents and young adults: a 3- to 5-year follow-up survey. Pediatrics. 1993, 92 (2): 212-218.PubMed
10.
Mannuzza S, Klein RG, Bonagura N, Malloy P, Giampino TL, Addalli KA: Hyperactive boys almost grown up. V. Replication of psychiatric status. Arch Gen Psychiatry. 1991, 48 (1): 77-83.CrossRefPubMed
11.
Mannuzza S, Klein RG, Bessler A, Malloy P, LaPadula M: Adult psychiatric status of hyperactive boys grown up. Am J Psychiatry. 1998, 155 (4): 493-498.CrossRefPubMed
12.
Hart EL, Lahey BB, Loeber R, Applegate B, Frick PJ: Developmental change in attention-deficit hyperactivity disorder in boys: a four-year longitudinal study. J Abnorm Child Psychol. 1995, 23 (6): 729-749. 10.1007/BF01447474.CrossRefPubMed
13.
Rasmussen P, Gillberg C: Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. J Am Acad Child Adolesc Psychiatry. 2000, 39 (11): 1424-1431. 10.1097/00004583-200011000-00017.CrossRefPubMed
14.
Harpin VA: The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child. 2005, 90 (Suppl 1): i2-7. 10.1136/adc.2004.059006.CrossRefPubMedPubMedCentral
15.
Alvarez C, Barriento R: Variability and tendencies in the consumption of methylphenidate in Spain. An estimation of the prevalence of attention deficit hyperactivity disorder. Rev Neurol. 2003, 37: 806-810.
16.
Garcia-Jimenez MC, Lopez-Pison J, Blasco-Arellano MM: The primary care paediatrician in attention deficit hyperactivity disorder. An approach involving a population study. Rev Neurol. 2005, 41 (2): 75-80.PubMed
17.
Cardo E, Servera M, Llobera J: Estimation of the prevalence of attention deficit hyperactivity disorder among the standard population on the island of Majorca. Rev Neurol. 2007, 44 (1): 10-14.PubMed
18.
19.
Escobar R, Soutullo C, Sebastian S, Fernandez E, Julian I, Lahortiga F: Atomoxetine safety and efficacy in children with attention deficit/hyperactivity disorder (ADHD): initial phase of 10-week treatment in a relapse prevention study with a Spanish sample. Actas Esp Psiquiatr. 2005, 33 (1): 26-32.PubMed
20.
Harpin VA: Medication options when treating children and adolescents with ADHD: interpreting the NICE guidance 2006. Arch Dis Child Educ Pract Ed. 2008, 93 (2): 58-65. 10.1136/adc.2006.106864.CrossRefPubMed
21.
King S, Griffin S, Hodges Z, Weatherly H, Asseburg C, Richardson G, Golder S, Taylor E, Drummond M, Riemsma R: A systematicreview and economic model of the effectiveness and cost-effectivenessof methylphenidate, dexamfetamine and atomoxetine for the treatmentof attention deficit hyperactivity disorder in children andadolescents. Health Technol Assess. 2006, 10 (23): iii-iv. xiii-146CrossRefPubMed
22.
Schlander M: Health Technology Assessments by the National Institute for Health and Clinical Excellence. A Qualitative Study. 2007, New York: Springer
23.
Kelsey DK, Sumner CR, Casat CD: Once-Daily Atomoxetine Treatment for Children With Attention-Deficit/Hyperactivity Disorder, Including an Assessment of Evening and Morning Behavior: A Double-Blind, Placebo-Controlled Trial. Paediatrics. 2004, 114: 1-8. 10.1542/peds.114.1.e1.CrossRef
24.
Pelham WE, Gnagy EM, Burrows-Maclean L, Williams A, Fabiano GA, Morrisey SM, Chronis AM, Forehand GL, Nguyen CA, Hoffman MT, et al: Once-a-day Concerta methylphenidate versus three-times-daily methylphenidate in laboratory and natural settings. Pediatrics. 2001, 107 (6): E105-10.1542/peds.107.6.e105.CrossRefPubMed
25.
Swanson J, Gupta S, Lam A, Shoulson I, Lerner M, Modi N, Lindemulder E, Wigal S: Development of a new once-a-day formulation of methylphenidate for the treatment of attention-deficit/hyperactivity disorder: proof-of-concept and proof-of-product studies. Arch Gen Psychiatry. 2003, 60 (2): 204-211. 10.1001/archpsyc.60.2.204.CrossRefPubMed
26.
Wolraich ML, Greenhill LL, Pelham W, Swanson J, Wilens T, Palumbo D, Atkins M, McBurnett K, Bukstein O, August G: Randomized, controlled trial of oros methylphenidate once a day in children with attention-deficit/hyperactivity disorder. Pediatrics. 2001, 108 (4): 883-892. 10.1542/peds.108.4.883.CrossRefPubMed
27.
Cottrell S, Tilden D, Robinson P, Bae J, Arellano J, Edgell E, Aristides M, Boye KS: A Modeled Economic Evaluation ComparingAtomoxetine with Stimulant Therapy in the Treatment of Children withAttention-Deficit/Hyperactivity Disorder in the United Kingdom. Value Health. 2008, 11 (3): 376-388. doi:10.1111/j.1524-4733.CrossRefPubMed
28.
Brown TE: Emerging Understanding of Attention-Deficit Disorders and Comorbidities in Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adult. 2000, Washington, DC: American Psychiatric Press
29.
30.
Newcorn JH, Zhang S, Rogers AK, Levine LR: Atomoxetine treatment response in ADHD patients naive to previous pharmacotherapy [abstract]. American Academy of Child and Adolescent Psychiatry 51th Annual Meeting; October 19–24. 2004, , Washington DC
31.
Efron D, Jarman F, Barke M: Methylphenidate versus dexamphetamine in children with attention deficit hyperactivity disorder: a double-blind, crossover trial. Pediatrics. 1997, 100 (6): E6-10.1542/peds.100.6.e6.CrossRefPubMed
32.
TreeAge Software. Inc: TreeAge Software: TreeAge Pro2007. Williamstown MA. 2007
33.
Sonnenberg FA, Beck R: Markov Models in Medical Decision Marking: A Practical Guide. Med Decis Making. 1993, 13: 322-338. 10.1177/0272989X9301300409.CrossRefPubMed
34.
35.
36.
37.
Secnik K, Matza LS, Cottrell S, Edgell E, Tilden D, Mannix S: Health state utilities for childhood attention-deficit/hyperactivity disorder based on parent preferences in the United kingdom. Med Decis Making. 2005, 25 (1): 56-70. 10.1177/0272989X04273140.CrossRefPubMed
38.
Michelson D, Faries D, Wernicke J, Kelsey D, Kendrick K, Sallee FR, Spencer T: Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. Pediatrics. 2001, 108 (5): E83-10.1542/peds.108.5.e83.CrossRefPubMed
39.
Spencer T, Heiligenstein JH, Biederman J, Faries DE, Kratochvil CJ, Conners CK, Potter WZ: Results from 2 proof-of-concept, placebo-controlled studies of atomoxetine in children with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2002, 63 (12): 1140-1147.CrossRefPubMed
40.
Michelson D, Allen AJ, Busner J, Casat C, Dunn D, Kratochvil C, Newcorn J, Sallee FR, Sangal RB, Saylor K, et al: Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. Am J Psychiatry. 2002, 159 (11): 1896-1901. 10.1176/appi.ajp.159.11.1896.CrossRefPubMed
41.
Kurlan R, Allen AJ, Gilbert D, Linder S, Lewis D, Winner P, Dunn D, Sallee FR, Milton D, Mintz M, et al: Atomoxetine Treatment In Children With ADHD And Comorbid Tic Disorders. Neurology. 2005, 65: 1941-1949. 10.1212/01.wnl.0000188869.58300.a7.CrossRefPubMed
42.
Weiss M, Tannock R, Kratochvil C, Dunn D, Velez-Borras J, Thomason C, Tamura R, Kelsey D, Stevens L, Allen AJ: A randomized, placebo-controlled study of once-daily atomoxetine in the school setting in children with ADHD. J Am Acad Child Adolesc Psychiatry. 2005, 44 (7): 647-655. 10.1097/01.chi.0000163280.47221.c9.CrossRefPubMed
43.
Gillberg C, Lothgren M, Fitzgerald P, Cottrell S, Burridge J, Aristides M: Atomoxetine versus methylphenidate as a treatment for ADHD in children and adolescents: A meta-analysis of safety data incorporating active comparator and placebo controlled trials [abstract/poster presentation]. European Society for Child and Adolescent Psychiatry (ESCAP): 28 Sep – 1. 2003, Oct , Paris, France
44.
Schachter HM, Pham B, King J, Langford S, Moher D: How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ. 2001, 165 (11): 1475-1488.PubMedPubMedCentral
45.
Bae JP: Meta-regression Analysis of Efficacy in Atomoxetine Randomized Controlled ADHD Trials [Podium presentation]. European International Society of Pharmacoeconomic and Outcomes Research (EISPOR): 6–9. 2004, Nov , Florence, Italy
46.
Kratochvil CJ, Heiligenstein JH, Dittmann R, Spencer TJ, Biederman J, Wernicke J, Newcorn JH, Casat C, Milton D, Michelson D: Atomoxetine and methylphenidate treatment in children with ADHD: a prospective, randomized, open-label trial. J Am Acad Child Adolesc Psychiatry. 2002, 41 (7): 776-784. 10.1097/00004583-200207000-00008.CrossRefPubMed
47.
Newcorn JH, Kratochvil CJ, Allen AJ, Casat CD, Ruff DD, Moore RJ, Michelson D: Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response. Am J Psychiatry. 2008, 165 (6): 721-730. 10.1176/appi.ajp.2007.05091676.CrossRefPubMed
48.
Michelson D, Buitelaar JK, Danckaerts M, Gillberg C, Spencer TJ, Zuddas A, Faries DE, Zhang S, Biederman J: Relapse prevention in pediatric patients with ADHD treated with atomoxetine: a randomized, double-blind, placebo-controlled study. J Am Acad Child Adolesc Psychiatry. 2004, 43 (7): 896-904. 10.1097/01.chi.0000125089.35109.81.CrossRefPubMed
49.
Sacristán JA, Oliva J, Del Llano J, Prieto L, Pinto JL: What is an efficient health technology in Spain?. Gac Sanit. 2002, 16: 334-343.CrossRefPubMed
50.
Schlander M: Long-acting medications for the hyperkinetic disorders. A note on cost-effectiveness. Eur Child Adolesc Psychiatry. 2007, 16 (7): 421-429. 10.1007/s00787-007-0615-2.CrossRefPubMed
51.
Taylor E, Dopfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Rothenberger A, Sonuga-Barke E, et al: European clinical guidelines for hyperkinetic disorder – first upgrade. Eur Child Adolesc Psychiatry. 2004, 13 (Suppl 1): I7-30.PubMed
52.
Foster EM, Jensen PS, Schlander M, Pelham WE, Hechtman L, Arnold LE, Swanson JM, Wigal T: Treatment for ADHD: is more complex treatment cost-effective for more complex cases?. Health Serv Res. 2007, 42 (1 Pt 1): 165-182. 10.1111/j.1475-6773.2006.00599.x.CrossRefPubMedPubMedCentral
Metadata
Title
A modelled economic evaluation comparing atomoxetine with methylphenidate in the treatment of children with attention-deficit/hyperactivity disorder in Spain
Authors
Jihyung Hong
Tatiana Dilla
Jorge Arellano
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2009
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-9-15

Other articles of this Issue 1/2009

BMC Psychiatry 1/2009 Go to the issue

Research article

Association study of promoter polymorphisms at the dopamine transporter gene in Attention Deficit Hyperactivity Disorder

Research article

Treatment patterns and clinical characteristics prior to initiating depot typical antipsychotics for nonadherent schizophrenia patients

Research article

The development of a knowledge test of depression and its treatment for patients suffering from non-psychotic depression: a psychometric assessment

Research article

The consumption of Internet child pornography and violent and sex offending

Research article

Persistence and compliance to antidepressant treatment in patients with depression: A chart review

Research article

The PsyCoLaus study: methodology and characteristics of the sample of a population-based survey on psychiatric disorders and their association with genetic and cardiovascular risk factors