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Long-Acting Methylphenidate-OROS in Youths with Attention-Deficit Hyperactivity Disorder Suboptimally Controlled with Immediate-Release Methylphenidate

A Study of Cost Effectiveness in The Netherlands

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Abstract

Background: Attention-deficit hyperactivity disorder (ADHD) is the most common mental health disorder in youths. Stimulants are the drugs of first choice in the treatment of ADHD. It has been suggested that full costs associated with the treatment of ADHD may be reduced by once-daily administration regimens of stimulants.

Objectives: To estimate the cost effectiveness of treatment with long-acting methylphenidate osmotic release oral system (OROS) [Concerta®] for youths with ADHD for whom treatment with immediate-release (IR) methylphenidate is suboptimal.

Study design: We developed a Markov model to obtain an incremental cost-effectiveness ratio (ICER). The analysis covered 10 years, with a Markov cycle of 1 day. Costs (in 2005 euros [€]) included medication, consultations and treatment interventions, and additional costs for attending special education. Quality-adjusted life-years (QALYs) were used as the effectiveness measure. Outcome probabilities were taken from the medical literature and an expert panel of five child psychiatrists and paediatricians. Univariate sensitivity analyses were performed to assess the robustness of the base-case estimate. Multivariate sensitivity analysis was used to estimate a worst- and best-case ICER.

Results: The ICER of methylphenidate-OROS treatment in youths with ADHD for whom treatment with IR methylphenidate is suboptimal was €2004 per QALY. Total costs after 10 years were €15 739 for the IR methylphenidate pathway and €16 015 for the methylphenidate-OROS pathway. In the univariate sensitivity analysis, the ICER was sensitive to changes in resource use and the robability of stopping stimulant treatment in favour of IR methylphenidate. An ICER of 0 was reached with a 6.2% price reduction of methylphenidate-OROS.

Conclusion: Methylphenidate-OROS is a cost-effective treatment for youths with ADHD for whom treatment with IR methylphenidate is suboptimal. Higher medication costs of methylphenidate-OROS were compensated for by savings on resource use, yielding similar 10-year costs compared with treatment with IR methylphenidate. Our analysis is sensitive to both clinical parameters and (differences in) resource utilization and costs between the groups modelled, warranting further research within clinical trials and observational databases, and into the full scope of costs.

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  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

This study was financially supported by Janssen Cilag B.V. (The Netherlands). The sponsor had no role in conducting the study or in the collection, management, analysis and interpretation of the data. M. van Agthoven is an employee of the sponsor. He gave advice about the study design and wrote, reviewed and approved the manuscript. The publication of this study was not contingent on the sponsor’s approval or censorship of the manuscript.

M. van Agthoven is an employee of Janssen Cilag B.V. In the past, L.J. Kalverdijk has received honoraria for research advice and an unrestricted research grant from Janssen Cilag B.V. Furthermore, he received speaker’s honoraria from Janssen Cilag B.V. and Eli-Lilly and appeared at hearings of the Pharmaceutical Care committee (CFH) of the Health Care Insurance Board in the case of Concerta and Strattera. A. Faber, H. Tobi and M.J. Postma received an unrestricted research grant from Janssen Cilag B.V. L.T.W. de Jong-van den Berg and L. Annemans have no conflict of interests directly relevant to this study. This report greatly benefited from the comments of three anonymous referees for CNS Drugs.

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Authors and Affiliations

  1. Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration (GUIDE), University of Groningen, Groningen, The Netherlands

    Adrianne Faber, Hilde Tobi, Lolkje T. W. de Jong-van den Berg & Maarten J. Postma

  2. SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE, Leiden, The Netherlands

    Adrianne Faber

  3. Janssen-Cilag B.V., Tilburg, The Netherlands

    Michel van Agthoven

  4. University Centre for Child and Adolescent Psychiatry, Groningen, The Netherlands

    Luuk J. Kalverdijk

  5. Social Sciences, Research Methodology Group, Wageningen University Research, Wageningen, The Netherlands

    Hilde Tobi

  6. Ghent University, Ghent, Belgium

    Lieven Annemans

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  1. Adrianne Faber
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  2. Michel van Agthoven
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  4. Hilde Tobi
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  7. Maarten J. Postma
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Correspondence to Adrianne Faber.

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Faber, A., van Agthoven, M., Kalverdijk, L.J. et al. Long-Acting Methylphenidate-OROS in Youths with Attention-Deficit Hyperactivity Disorder Suboptimally Controlled with Immediate-Release Methylphenidate. CNS Drugs 22, 157–170 (2008). https://doi.org/10.2165/00023210-200822020-00006

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