Cost-Effectiveness of Off-Label Antipsychotics in Children and Adolescents
2016
This article, published in Attention Deficit and Hyperactivity Disorders, presents a decision tree to evaluate the cost-effectiveness of atypical antipsychotics (AAPs) to other non-stimulant ADHD medications in treating children and adolescents with ADHD who failed initial stimulant treatment. The strategies compared in the analysis are: (1) AAPs, (2) a selective norepinephrine reuptake inhibitor (atomoxetine), and (3) selective α2-adrenergic agonists (clonidine and guanfacine). Data on the input parameters of the model are derived from the literature. The analysis is conducted from the third-payer perspective and the time horizon was 1 year. To investigate the impact of uncertainty in model input parameters on the results one-way sensitivity analyses and Monte Carlo simulation is performed.
The results of this study indicate that clonidine/guanfacine show the highest number of QALYs (expected QALY = 0.95) followed by atomoxetine (expected QALY = 0.94). Atypical antipsychotics yield the lowest health outcomes with an expected QALY of 0.84. The cost-effectiveness analysis demonstrates that the AAP strategy is dominated (i.e., less effective and more costly) by the other two strategies. Compared to clonidine/guanfacine, AAPs provide a lower number of QALYs (0.11 QALY lost) at an additional cost of $2,186. Compared to atomoxetine, AAPs result in 0.10 QALYs lost at an additional cost of $2,186.
Based on these findings the authors conclude that AAPs provide lower expected health outcomes than other ADHD medications in children and adolescents who failed prior stimulant therapy and that AAPs are not a cost-effective option in this patient population.
Cost-Effectiveness of Off-Label Antipsychotics in Children and Adolescents
Source:
Sohn M, Talbert J, Moga DC et al. A Cost-Effectiveness Analysis of Off-Label Atypical Antipsychotic Treatment in Children and Adolescents with ADHD Who Have Failed Stimulant Therapy. Attention Deficit and Hyperactivity Disorders 2016; 8 (3): 149-158. https://doi.org/10.1007/s12402-016-0198-1