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Treatments with versus without medication for children with behavioural difficulties in clinical practice: an

Caitlin K Kiernan1,2,3, Hermien H Dijk1,2,3, Barbara J van den Hoofdakker1,2,4

  • 1Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Journal of Child Psychology and Psychiatry, and Allied Disciplines
|September 30, 2024
PubMed

Insights

This study found no significant cost-effectiveness differences between medication and non-medication treatments for children with behavioral issues like ADHD and ODD in real-world clinical practice. Further research is needed for definitive conclusions on treatment utility.

Area of Science:

  • Pediatric mental healthcare
  • Health economics
  • Behavioral science

Background:

  • Traditional economic evaluations for childhood behavioral disorders (ADHD/ODD) often use limited trial or model data.
  • Real-world clinical practice data may offer more representative cost-effectiveness and cost-utility insights.
  • This study addresses this gap by evaluating treatments using observational data.

Purpose of the Study:

  • To conduct an economic evaluation of treatments for children experiencing hyperactivity, inattention, and behavioral difficulties.
  • To compare the cost-effectiveness and cost-utility of medication versus non-medication treatments in a clinical setting.
  • To utilize longitudinal observational data for a more practical assessment.

Main Methods:

  • A longitudinal study of 209 children (aged 5-12) receiving youth mental healthcare.
  • Comparison of treatment groups: with medication (n=108) and without medication (n=101).
  • Propensity score matching ensured group comparability; outcomes included QALYs, symptom severity, and impairment; societal costs were assessed.

Main Results:

  • No statistically significant differences in costs or effects were found between medication and non-medication treatment groups.
  • Cost-effectiveness acceptability curves (CEACs) indicated a 55% probability of cost-effectiveness for medication at a €80,000 threshold.
  • The probability of cost-effectiveness for medication decreased to 36% at a €20,000 threshold.

Conclusions:

  • Observational data did not yield conclusive evidence on the cost-effectiveness or cost-utility of medication versus non-medication treatments in clinical practice.
  • The findings highlight the complexity of economic evaluations in pediatric mental healthcare.
  • Further investigation may be warranted to clarify the value of medication in treating childhood behavioral disorders.
Abstract

Keywords:
ADHDEconomic evaluationbehaviour problemslongitudinal studiespharmacotherapy

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