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Cost-Effectiveness of Treatments in Children With Attention-Deficit/Hyperactivity Disorder: A Continuous-Time Markov
Roel D Freriks1, Jochen O Mierau1, Jurjen van der Schans2
1Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands.
Insights
Treatments for attention-deficit/hyperactivity disorder (ADHD) in children were evaluated for cost-effectiveness. Surprisingly, standard ADHD treatments were less effective than community care in preventing serious delinquency.
Area of Science:
- Health Economics
- Child Psychiatry
- Behavioral Science
Background:
- Attention-deficit/hyperactivity disorder (ADHD) significantly impacts children's lives, with potential long-term consequences.
- Preventing serious delinquent behavior is a critical societal outcome linked to effective ADHD management.
- Previous cost-effectiveness studies often focus on direct treatment costs, not broader societal impacts.
Purpose of the Study:
- To assess the cost-effectiveness of major ADHD treatments (medication, behavioral, combined) versus community care.
- To evaluate treatments based on preventing serious delinquent behavior in children.
- To determine the net monetary benefit (NMB) of different ADHD intervention strategies.
Main Methods:
- Utilized data from the Multimodal Treatment Study of Children with ADHD (n=448, ages 7-10).
- Developed a continuous-time Markov model to simulate outcomes over 10 years post-trial.
- Calculated NMB using a willingness-to-pay threshold based on the societal cost of serious delinquency.
Main Results:
- Modeled outcomes closely matched observed data, with a 6.9% mean difference in life-years (LYs) of delinquency prevented.
- Routine community care yielded the highest NMB ($98,660), followed by medication management ($95,449), combined treatment ($90,536), and behavioral treatment ($88,553).
- Sensitivity analyses confirmed the stability of these NMB estimates across a range of willingness-to-pay thresholds.
Conclusions:
- Standard ADHD treatments were found to be less cost-effective than routine community care in preventing serious delinquency.
- Evaluating ADHD treatments through broader societal outcomes, like delinquency prevention, is crucial for policy decisions.
- The findings underscore the need to consider long-term societal impacts when assessing the value of child mental health interventions.
Abstract:
Objectives. This study aimed to assess the cost-effectiveness of treatments for attention-deficit/hyperactivity disorder (ADHD) in children through prevention of serious delinquent behavior. Cost-effectiveness was assessed in net-monetary benefit (NMB). Methods. To evaluate the three major forms of ADHD treatment (medication management, behavioral treatment, and the combination thereof) relative to community-delivered treatment (control condition), we used data from 448 children, aged 7 to 10, who participated in the National Institute of Mental Health's Multimodal Treatment Study of Children with ADHD. We developed a three-state continuous-time Markov model (no delinquency, minor to moderate delinquency, serious delinquency) to extrapolate the results 10 years beyond the 14-month trial period at a 3% discount rate. Serious delinquency was considered an absorbing state to enable assessment in life-years (LYs) of serious delinquent behavior prevented. The willingness-to-pay (WTP) threshold was set equal to the annual cost associated with serious delinquency in children with ADHD of $12,370. Results. Modeled and observed outcomes matched closely with a mean difference of 6.9% in LYs of serious delinquent behavior prevented. The economic evaluation revealed a NMB of $95,449, $88,553, $90,536 and $98,660 for medication management, behavioral treatment, combined treatment, and routine community care, respectively. Estimates remained stable after linearly increasing the WTP threshold between $0 and $50,000 in the deterministic sensitivity analyses. Conclusions. This study assessed the cost-effectiveness of treatments for ADHD in children using continuous-time Markov modeling. We show that treatment evaluation in broader societal outcomes is essential for policy makers, as the three major forms of ADHD treatment turned out to be inferior to the control condition.
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