Zimovetz EA, Beard SM, Hodgkins P, Bischof M, Mauskopf JA, Setyawan J. A cost-utility analysis of lisdexamfetamine versus atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder and inadequate response to methylphenidate. CNS Drugs. 2016 Oct;30(10):985-96.


BACKGROUND: An economic analysis from the United Kingdom's (UK's) National Health Service (NHS) perspective evaluated the cost-effectiveness of lisdexamfetamine dimesylate (LDX) compared with atomoxetine (ATX) in children and adolescents with attentiondeficit/hyperactivity disorder who have had an inadequate response to methylphenidate (MPH).  

METHODS:
A 1-year decision-analytic model was constructed, with health outcomes "response," "nonresponse," and "unable to tolerate". Clinical data were taken from a head-to-head, randomized, controlled trial in inadequate responders to MPH. Response to treatment was defined as a score of 1 (much improved) or 2 (improved) on the Clinical Global Impression-Improvement subscale. Tolerability was assessed by discontinuation rates owing to adverse events. Utility weights were identified via a systematic literature review. Health-care resource use estimates were obtained via a survey of clinicians. Daily drug costs were derived from mean doses reported in the trial. One-way and probabilistic sensitivity analyses (PSAs) were performed.  

RESULTS:  The comparison of LDX with ATX resulted in an estimate of an incremental cost-effectiveness ratio of £1,802 per quality-adjusted life-year (QALY). The result was robust in a wide range of sensitivity analyses; results were most sensitive to changes in drug costs and efficacy. In the PSA, assuming a maximum willingness to pay of £20,000 per QALY, LDX versus ATX had an 86% probability of being cost-effective. In 38% of PSA runs, LDX was more effective and less costly than ATX.  

CONCLUSIONS:  From the perspective of the UK NHS, LDX provides a cost-effective treatment option for children and adolescents who are inadequate responders to MPH.

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