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. 2007 Nov 15;1:13. doi: 10.1186/1753-2000-1-13

Table 4.

Key assumptions underlying scenarios (base case and extreme cases)

Key assumptions1 Low Case (Extreme) Base Case (Projection) High Case (Extreme)
Adjustments (all scenarios) Germany: narcolepsy 2% of prescriptions in 2003; adult ADHD accounts for 10% of prescriptions in 2003
England: ProvigilR prescriptions cover narcolepsy exhaustively, no off-label use of modafinil for ADHD; modafinil for ADHD will be priced at the same level as ProvigilR; adult ADHD accounts for 10% of prescriptions in 2003
Peak diagnosis prevalence England: 3.90%
Germany: 4.20%		 England: 3.90%
Germany: 4.50%		 England: 4.20%
Germany: 4.80%
Peak treatment prevalence England: 2.54%
Germany: 3.15%		 England: 2.54%
Germany: 3.38%		 England: 2.94%
Germany: 3.84%
New product availability dMPH (FocalinR) 2007;
MPH-TDS 2008;
LisDEX 2008;
ARM/MOD ./.		 dMPH (FocalinR) 2007;
MPH-TDS 2008;
LisDEX 2008;
ARM/MOD 2009
New products, specific notes ARM/MOD not approved;
LisDEX without clinical advantage over MPH-MR;
dMPH (IR/MR) profile comparable to MPH-IR and MPH-MR08, respectively;
MPH-TDS advantage limited to "convenience", no sensitization problems		 ARM/MOD comparable to ATX;
LisDEX: reduced abuse and diversion potential shown;
dMPH (FocalinR) profile comparable to MPH-IR (dMPH-IR) and MPH-MR08 (dMPH-MR), respectively;
MPH-TDS advantage limited to "convenience", no sensitization problems		 ARM comparable to ATX;
LisDEX: non-scheduled for reduced abuse potential;
dMPH (FocalinR) profile comparable to MPH-IR and MPH-MR08, respectively;
MPH-TDS advantage limited to "convenience", no sensitization problems
New product pricing FocalinR = branded MPH-IR;
FocalinR XR = MPH-MR12;
LisDEX and MPH-TDS 50% premium over MPH-MR12;
ARM/MOD n.a.		 Price of dMPH-IR (FocalinR) = branded MPH-IR;
dMPH-MR (FocalinR XR) = MPH-MR12;
LisDEX and MPH-TDS 50% price premium over MPH-MR12;
ARM/MOD = ATX (20% b.i.d.) in Germany;
ARM/MOD for ADHD in England priced like ProvigilR.		 FocalinR = branded MPH-IR;
FocalinR XR = MPH-MR12;
LisDEX and MPH-TDS 100% premium over MPH-MR12;
ARM/MOD = LisDEX (D)
Established products No price increases (except for DEX in England in "Extremely High Case" scenario).
Generic MPH-IR market up to 90% (Germany) or 95% (England), respectively; FocalinR up to 20% of MPH-IR market share.
No generic substitution for ATX or MPH-MR market segments.
ATX administered b.i.d. in 20% of patients.
Treatment intensity No change compared to 2005 (current trend ends 2006) Continuation of current trend, phasing out by 2010 Continuation of current trend, phasing out by 2012

1Abbreviations: MPH: methylphenidate; IR: immediate-release formulations (RitalinR, branded generics [EquasymR, MedikinetR], generics; FocalinR); MR: modified-release formulations (MPH-MR12: ConcertaR XL; MPH-MR08: EquasymR XL, MedikinetR retard, FocalinR XR; MPH-TDS: transdermal system (patch, DaytranaR); LisDEX: lisdexamphetamine (NRP104); Nonstimulants: ATX, atomoxetine (StratteraR), ARM, armodafinil (NuvigilR); DEX: dexamphetamine (England only)