Abstract
Background: Attention-deficit hyperactivity disorder (ADHD) is a complex neuropsychiatric disorder that affects children and young people, as well as adults. Since ADHD does not produce specific organic characteristics, behavior and preferences are crucial to diagnosis and treatment. Comprehensive therapy concepts should take full account of the needs of the patients.
Objective: To document therapy attributes that are important from the adults’ perspective and to analyze findings from two different valuation approaches used in the same survey.
Methods: A self-administered survey measuring attitudes and preferences was conducted in Germany in 2009 (n = 329). Adult patients (aged ≥18 years) were recruited from all over Germany, with the help of patient advocacy organizations. Attitudes were measured and analyzed using a classic rating scale in 5-point Likert format. Discrete-choice experiment (DCE) scenarios were developed using a fractional factorial design and results were analyzed using random effects logit models.
Results: The aspect of highest importance for the respondents was that social function (job, studies, friendships) was not impaired (coefficient 2.115; standard error 0.111). The next most important in the view of the respondents was achievement of behavioral changes through treatment (coefficient 1.755; standard error 0.110). The ‘drug intake’ aspect was not important in the attitude component rating and not significant in the DCE.
Conclusions: The primary goal of ADHD treatment is by no means the alleviation of core symptoms. Instead, therapy should help enable patients to set and achieve their own objectives. Treatment should enable patients to organize their social participation in everyday life.
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References
Barkley RA, Fischer M, Smallish L, et al. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol 2002; 111(2): 279–89
Faraone SV, Biederman J, Spencer T, et al. Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry 2000; 48(1): 9–20
Able SL, Johnston JA, Adler LA, et al. Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychol Med 2007; 37(1): 97–107
Barkley RA. Challenges in diagnosing adults with ADHD. J Clin Psychiatry 2009; 69(12): e36
Kendall T, Taylor E, Perez A, et al. Diagnosis and management of attention-deficit/hyperactivity disorder in children, young people, and adults: summary of NICE guidance. BMJ 2008 Sep 24; 337: a1239 [online]. Available from URL: http://www.bmj.com/cgi/content/extract/337/sep24_1/ a1239 [Accessed 2010 Aug 25]
Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder: first upgrade. Eur Child Adolesc Psychiatry 2004; 13Suppl. 1:I7–30
Wasserstein J. Diagnostic issues for adolescents and adults with ADHD. J Clin Psychol 2005; 61(5): 535–47
Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 2000; 157(5): 816–8
Edel M-A. Epidemiologie der ADHS. In: Edel M-A, Vollmoeller W, editors. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen. Heidelberg: Springer, 2005: XII, 157 S
Bundesärztekammer (2005) Stellungnahme zur “Aufmerks-amkeitsdefizit-/Hyperaktivitätsstörung (ADHS)” [online]. Available from URL: http://www.bundesaerztekammer. de/downloads/ADHSLang.pdf [Accessed 2010 Aug 18]
Döpfner M, Steinhausen HC, Coghill D, et al. Cross-cultural reliability and validity of ADHD assessed by the ADHD rating scale in a pan-European study [published erratum appears in Eur Child Adolesc Psychiatry 2009; 18 (3): 194-6]. Eur Child Adolesc Psychiatry 2006; 15Suppl. 1:I46–55
Polanczyk G, de Lima MS, Horta BL, et al. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007; 164(6): 942–8
Harpin VA. The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child 2005; 90Suppl. 1: i2–7
Miranda A, Jarque S, Rosel J. Treatment of children with ADHD: psychopedagogical program at school versus psychostimulant medication. Psicothema 2006; 18(3): 335–41
National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults [clinical guideline 72]. London: NICE, 2008 [online]. Available from URL: http://www.nice.org.uk/nicemedia/ pdf/CG72NiceGuidelinev3.pdf [Accessed 2010 Aug 18]
Weiss M, Murray C. Assessment and management of attention-deficit hyperactivity disorder in adults. CMAJ 2003; 168(6): 715–22
Banaschewski T, Coghill D, Santosh P, et al. Long-acting medications for the hyperkinetic disorders: a systematic review and European treatment guideline. Eur Child Adolesc Psychiatry 2006; 15(8): 476–95
Cunningham CE, Deal K, Rimas H, et al. Modeling the information preferences of parents of children with mental health problems: a discrete choice conjoint experiment. J Abnorm Child Psychol 2008; 36(7): 1123–38
Cunningham CE, Deal K, Rimas H, et al. Providing information to parents of children with mental health problems: a discrete choice conjoint analysis of professional preferences. J Abnorm Child Psychol 2009; 37(8): 1089–102
Mühlbacher AC, Rudolph I, Lincke HJ, et al. Preferences for treatment of attention-deficit/hyperactivity disorder (ADHD): a discrete choice experiment. BMC Health Serv Res 2009; 9: 149
Ryan M, Gerard K, Amaya-Amaya M, editors. Using discrete choice experiments to value health and health care. The economics of non-market goods and resources series. Vol. 11. Dordrecht: Springer, 2008
Ryan M, Farrar S. Using conjoint analysis to elicit preferences for health care. BMJ 2000; 320: 1530–3
Ryan M, Gerard K. Using discrete choice experiments to value health care programmes: current practice and future research reflections. Appl Health Econ Health Policy 2003; 2(1): 55–64
Ryan M, Hughes J. Using conjoint analysis to assess women’s preferences for miscarriage management. Health Econ 1997; 6(3): 261–73
McFadden D. Conditional logit analysis of qualitative choice behavior [working paper]. Berkeley (CA): Institute of Urban & Regional Development, University of California, 1973: 199
Ben-Akiva ME, Lerman SR. Discrete choice analysis: theory and application to travel demand. MIT Press series in transportation studies. Cambridge (MA): MIT Press, 1985
Lancaster K. Consumer demand: a new approach. Columbia studies in economics. New York: Columbia University Press, 1971
Lancaster KJ. A new approach to consumer theory. Indianapolis (IN): Bobbs-Merrill, 1966
Hauber AB. Healthy-years equivalent: wounded but not yet dead. Exp Rev Pharmacoeconomics Outcomes Res 2009; 9(3): 265–70
Telser H, editor. Nutzenmessung im Gesundheitswesen: die Methode der Discrete-Choice-Experimente. S.v. Forschungsergebnisse. Vol. 78. Hamburg: Kova, 2002
Lancsar E, Louviere J. Conducting discrete choice experiments to inform healthcare decision making: a user’s guide. Pharmacoeconomics 2008; 26(8): 661–78
Lancsar E, Louviere J, Flynn T. Several methods to investigate relative attribute impact in stated preference experiments. Soc Sci Med 2007; 64(8): 1738–53
Mühlbacher AC, Nübling M. Analysis of physicians’ perspective versus patients’ preferences: direct assessment and discrete choice experiments in therapy of multiple myeloma Eur J Health Econ. Epub 2010 Jan 28
Mühlbacher AC, Rudolph I, Lincke HH, et al. Preferences for treatment of attention-deficit/hyperactivity disorder (ADHD): a discrete choice experiment. BMC Health Serv Res 2009 Aug 13; 9: 149
Telser H, Becker K, Zweifel P. Validity and reliability of willingness-to-pay estimates: evidence from two overlapping discrete-choice-experiments. Patient 2008; 1(4): 283–93
Mühlbacher AC, Lincke H-J, Nübling M. Evaluating patients’ preferences for multiple myeloma therapy, a discrete-choice-experiment. Psychosoc Med 2008; 5: Doc10
Johnson FR, Ozdemir S, Mansfield C, et al. Crohn’s disease patients’ risk-benefit preferences: serious adverse event risks versus treatment efficacy. Gastroenterology 2007; 133(3): 769–79
Johnson FR, Hauber AB, Özdemir S. Using conjoint analysis to estimate healthy-year equivalents for acute conditions: an application to vasomotor symptoms. Value Health 2009; 12(1): 146–52
Phillips KA, Johnson FR, Maddala T. Measuring what people value: a comparison of ‘attitude’ and ‘preference’ surveys. Health Serv Res 2002; 37(6): 1659–79
Baumgartner H, Steenkamp J-B. Response styles in marketing research: a cross-national investigation. J Mark Res 2001; 38(2): 143–56
Nübling M, Andersen HH, Mühlbacher A, et al. Computation of standard values for physical and mental health scale scores using the SOEP version of SF-12v2. Schmollers Jahrbuch 2007; 127(1): 171–82
Flynn TN, Louviere JJ, Peters TJ, et al. Best-worst scaling: what it can do for health care research and how to do it. J Health Econ 2007; 26(1): 171–89
Burgess L. Discrete choice experiments [computer software]. Sydney (NSW): Department of Mathematical Sciences, University of Technology, 2007
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press, 2001
Wasson JH, Johnson DJ, Benjamin R, et al. Patients report positive impacts of collaborative care. J Ambul Care Manage 2006; 29(3): 199–206
Acknowledgements
This research was financed with support from Janssen-Cilag, Neuss, Germany. The authors have no conflicts of interest that are directly relevant to the content of this article.
ACM and MN designed the study, carried out the data collection, and performed the statistical analysis and data interpretation. All authors contributed to interpretation of the data and critical revision of the manuscript and read and approved the final version.
The authors extend special thanks to the patient advocacy groups ‘ADHS Deutschland e. V.’ and ‘ BVAD e.V.’ for their support in conducting this study. The authors benefited from the assistance of Jilrgen Kaspar, Heidi Wurm, Lara Jackson, Lara Slawik, Frauke Kupfernagel, and Susanne Bethge.
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Mühlbacher, A.C., Nübling, M. Analysis of Patients’ Preferences. Patient-Patient-Centered-Outcome-Res 3, 285–294 (2010). https://doi.org/10.2165/11584640-000000000-000009
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DOI: https://doi.org/10.2165/11584640-000000000-000009