Table 3.
Summary of methods and results of the studies included
| Author, year | Type of evaluation | Analysis perspective | Health outcomes reported (instruments) | Costs included | Results (US$, 2020)a | Quality |
|---|---|---|---|---|---|---|
| ADHD | ||||||
| Tran et al. [40] | CEA | Modified societal | ADHD-I cases resolved based on parent and teacher completed CSI | Intervention costs (clinician time to run interventions, coordination time and supplies, teacher time); TAU: other healthcare costs (medication, psychotherapy from community providers), childcare, parents' time attending meetings and helping children with homework | Both PFT and CLAS had significantly less ADHD-I cases resolved than TAU. PFT had the lowest cost per patient (ICERs per ADHD-I cases resolved: $4,672 for CLAS versus TAU, $3,772 for PFT versus TAU, and $5,838 for CLAS versus PFT). | Moderate |
| Sonuga-Barke et al. [32] | CMA | Societal | SNAP-IV mean scores | Health care services (health clinics, health visitors, GPs, pediatric and mental health services); extra educational provision (school nurses, educational psychologist); social services and parental time off work | No differences between NFPP, IY and TAU with regards clinical effectiveness. Individually delivered NFPP was less costly to deliver than IY. No costs estimated for TAU | Good |
| Zimovetz et al. [33] | CUA | NHS | QALY (EQ5D) | Health care costs (GP, psychiatrist, pediatrician, nurse, blood work and other exams) and drug costs | From the perspective of the UK NHS, LDX provides a cost-effective treatment option for children and adolescents who are inadequate responders to methylphenidate (ICER = $3,017/QALY at a WTP of $33,485/QALY) | Good |
| Sohn et al. [34] | CUA | Third party payer | QALY (PedsQL) | Health care costs (hospitalizations, emergency room visits, outpatient visits), prescription drug costs | AAPs were less effective and more costly than clonidine/guanfacine and atomoxetine | Good |
| Maia et al. [35] | CUA | Public health system | QALY (HUI) | Treatment costs (drug and outpatient) | IR-MPH treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. ICER = $10,070/QALY (children); $13,145/QALY (adolescents) at a WTP of $38,264/QALY | Good |
| Lachaine, et al. [36] | CUA | Societal | QALY (TTO and VAS) | Health care services (primary care, mental health visits, pharmacy fills, emergency department visits and hospitalizations), medication, productivity losses for parents | GXR as an adjunctive therapy to long-acting stimulants is a cost-effective strategy compared to long-acting stimulant monotherapy in the treatment of children with ADHD. 100% cost-effective at WTP = $ 45,677/QALY. ICER = $21,669/QALY | Good |
| Schawo et al. [37] | CUA | Societal | QALY (EQ5D) | Treatment costs (drug and consultations), outpatient costs, institutionalization, psychoeducation, parent/teacher and home training, behavior therapy child, social skills training, physical therapy, criminal justice, educational support, special education, productivity losses parents, out-of pocket medical expenses | For children responding suboptimally to treatment with IR-MPH, the beneficial effect of MPH-OROS on compliance is worth the money. The probability of OROS being cost-effective ranges between 93 and 99%. Cost savings of $7,938 | Good |
| van der Schans, et al. [38] | CUA | Societal | QALY (TTO and VAS) | Medication costs, other direct costs (medical consultation, behavioral intervention, and special education) and indirect costs (due to direct medical costs of the mother, absenteeism and presenteeism) | Switching suboptimally treated patients from IR-MPH to MPH-OROS or Equasym XL/Medikinet CR led to per-patient cost-savings of $5,748 and $7,390, respectively, over a 10-year treatment span | Good |
| Erder et al. [41] | CEA, CUA | Third party payer | Proportion of responders, defined as patients with 25% reduction in ADHD-RS-IV total score, QALY (EQ5D) | Drug costs and other medical costs | GXR is cost-effective compared with ATX for the treatment of ADHD in children and adolescents. ICER: $12,357/QALY gained (WTP of $50,000/QALY); $1,005 per responder | Moderate |
| Sikirica et al. [39] | CUA | Third party payer | QALY (TTO and VAS) | Drug costs and other medical costs | The adjunctive therapy of GXR with stimulants is a cost-effective treatment compared to stimulant monotherapy. ICER = $37,780/QALY. 94.6% probability of cost-effectiveness at a WTP of $50,000/ QALY | Good |
| Autism spectrum disorders | ||||||
| Byford et al. [42] | CEA | Societal | Clinically meaningful improvement in ADOS-G social communication algorithm score | Health care (intervention, speech and language, community health, meds, hospital-based services), education, childcare, social services, parental productivity losses, parental out-of-pocket expenses, informal care | Non-significant improvements in outcome. Larger health, education and social services for PACT + TAU versus TAU. Total cost lower when burden on parents is included. No evidence for investment in PACT + TAU | Good |
| Penner et al. [43] | CEA | Societal | Dependency-free life years (DFLYs)b | Intervention costs, special education, special services at home, income support and healthcare, caregiver costs, productivity losses for children | Pre-diagnosis ASD-targeted intervention may be associated with cost savings (between $21,011 and $52,985) compared to current Ontario service models | Good |
AAP atypical antipsychotics, ADHD attention deficit/hyperactivity disorder, ADHD-RS-IV ADHD rating scale, ADOS-G autism diagnostic observation schedule-generic, ASD Autism spectrum disorder, ATX atomoxetine, CEA cost-effectiveness analysis, CLAS Child Life and Attention Skills, CMA cost-minimization analysis, CSI Child Symptom Inventory, CUA cost-utility analysis, EQ5D Euroqol 5 dimensions, GXR guanfacine extended release, HUI health utilities index, ICER incremental cost-effectiveness ratio, IR-MPH immediate-release methylphenidate, LDX Lisdexamfetamine dimesylate, MPH-OROS methylphenidate osmotic-release oral system, NFPP New Forest Parenting Program, NHS National Health Service, PACT Pre-school Autism Communication Trial, PedsQL Pediatric Quality of Life Inventory, PFT parent-focused treatment, QALY quality adjusted life year, SNAP-IV Swanson Nolan and Pelham, TAU treatment as usual, TTO time trade off, VAS visual analogue scale, WTP willingness-to-pay
aAll costs converted to 2020 US$ from original currency using a conversion rate based on Purchasing Power Parities (PPP) for gross domestic product from http://eppi.ioe.ac.uk/costconversion/default.aspx
bA DFLY was defined as a year of life with a similar level of independence as a typically developing individual
If more than one perspective, the broadest perspective was indicated