Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

• Main Authors: Carlos R. Maia, Steffan F. Stella, Flavia Wagner, Thiago G. Pianca, Fernanda V. Krieger, Luciane N. Cruz, Guilherme V. Polanczyk, Luís A. Rohde, Carísi A. Polanczyk
• Format: Article
• Language: English
• Published: Associação Brasileira de Psiquiatria (ABP) 2015-01-01
• Series: Brazilian Journal of Psychiatry
• Subjects: Attention deficit hyperactivity disorder; cost-utility analysis; methylphenidate
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462015005041516&lng=en&tlng=en

Objective:To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil.Method:A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years.Results:Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy.Discussion:MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy.Trial registration number:NCT01705613.