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

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neurobehavioral disorder characterized by inattention hyperactivity and impulsivity. Prevalence estimates in elementary school children generally range from 3% to 8%. ADHD is frequently treated with psychostimulant medications 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 commonly prescribed pharmacotherapies: methylphenidate immediate-release/extended-release (MPH IR/ER) methylphenidate immediate-release (MPH IR) Metadate® CD (branded MPH IR/ER) Concerta™ (branded MPH ER) Ritalin® (branded MPH IR) and Adderall® (a combination of dextroamphetamine and amphetamine salts). Methods: A literature review and clinical assessment using a 27-question survey instrument were used to capture information on the clinical characteristics of ADHD including common treatment regimens clinical management of patients pathways of care and components of care. A meta-analysis provided response rates for 3 commonly used pharmacotherapies: Metadate CD MPH IR and Adderall. Information from the clinical assessment and the meta-analysis were used to populate a decision-analytic model to compute total expected cost for each comparator. Results: The average total annual expected cost per patient was $1487 for Metadate CD $1631 for Concerta $1792 for MPH IR/ER $1845 for MPH IR $2080 for Ritalin and $2232 for Adderall. Conclusions: Metadate CD had the lowest total expected cost and Adderall had the highest total expected cost among the ADHD pharmacotherapies evaluated. The differences were attributable to differences in drug-acquisition costs and the need for in-school dosing of twice-daily and thrice-daily medications.