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Treatment for ADHD: Is More Complex Treatment Cost-Effective for More Complex Cases?

Authors

  • E. Michael Foster,

    1. The University of North Carolina, School of Public Health, 407-C Rosenau Hall, CB 7445, Chapel Hill, NC 27599,
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    • Address correspondence to E. Michael Foster, Ph.D., Department of Maternal and Child Health, The University of North Carolina, School of Public Health, 407-C Rosenau Hall, CB 7445, Chapel Hill, NC 27599. Peter S. Jensen, M.D., CACMH, is with the Columbia University/NYSPI, New York, NY. Michael Schlander, M.D., MBA, is with the University of Applied Economic Sciences Ludwigshafen, and University of Witten/Herdecke, Ludwigshafen am Rhein. William E. Pelham Jr., Ph.D., is with the The University at Buffalo, Buffalo, NY. Lily Hechtman, M.D., FRCP(C), is with the Montreal Children's Hospital, Montreal, Quebec, Canada. L. Eugene Arnold, Ph.D., is with The Ohio State University, Columbus, OH. James M. Swanson, Ph.D., and Tim Wigal, Ph.D., are with the UCI Child Development Center, Irvine, CA.

  • Peter S. Jensen,

    1. Columbia University/NYSPI, New York, NY,
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  • Michael Schlander,

    1. University of Applied Economic Sciences Ludwigshafen, and University of Witten/Herdecke, Ludwigshafen am Rhein,
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  • William E. Pelham Jr.,

    1. The University at Buffalo, Buffalo, NY,
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  • Lily Hechtman,

    1. Montreal Children's Hospital, Montreal, Quebec, Canada,
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  • L. Eugene Arnold,

    1. The Ohio State University, Columbus, OH
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  • James M. Swanson,

    1. UCI Child Development Center, Irvine, CA
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  • Timothy Wigal

    1. UCI Child Development Center, Irvine, CA
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Abstract

Objective. To determine the cost-effectiveness of three alternative high-quality treatments for attention deficit hyperactivity disorder (ADHD) relative to community care (CC) and to determine whether cost-effectiveness varies with the presence of comorbid disorders.

Data Sources/Collection. The study included 579 children ages 7–9.9 with diagnosed ADHD at six sites. Data for the study were distilled from administrative data and from interviews with parents, including estimates of the child's functional impairment. These analyses focus on changes in functional impairment over 14 months.

Study Design. The study involved a large clinical trial that randomized participants to one of four arms: routine CC, intensive medication management (MedMgt), multicomponent behavioral treatment, and a combination of behavioral treatment and medication.

Principal Findings. We assessed the cost-effectiveness of the alternatives using costs measured from a payer perspective. The preferred cost-effective treatment varies as a function of the child's comorbidity and of the policy maker's willingness to pay. For pure (no comorbidity) ADHD, high-quality MedMgt appears likely to be cost-effective at all levels of willingness to pay. In contrast, for some comorbid conditions, willingness to pay is critical: the policy maker with low willingness to pay likely will judge MedMgt most cost-effective. On the other hand, a policy maker willing to pay more now in expectation of future costs savings (involving, for example, juvenile justice), will recognize that the most cost-effective choice for comorbid conditions likely involves behavior therapy, with or without medication.

Conclusions: Analyses of costs and effectiveness of treatment for ADHD must consider the role of comorbidities.

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