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
Zimovetz, E., Beard, S., Hodgkins, P., Bischof, M., Mauskopf, J., & Setyawan, J. (2016). 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, 30(10), 985–996. Advance online publication. https://doi.org/10.1007/s40263-016-0354-3
An economic analysis from the perspective of the UK National Health Service (NHS) evaluated the cost effectiveness of lisdexamfetamine dimesylate (LDX) compared with atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder who have had an inadequate response to methylphenidate.A 1-year decision-analytic model was constructed, with the health outcomes "response", "nonresponse", and "unable to tolerate". Clinical data were taken from a head-to-head, randomized controlled trial in inadequate responders to methylphenidate. Response to treatment was defined as a score of 1 (very much improved) or 2 (much 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. Healthcare resource use estimates were obtained via a survey of clinicians. Daily drug costs were derived from British National Formulary 2012 costs and mean doses reported in the trial. One-way and probabilistic sensitivity analyses (PSAs) were performed.The comparison of LDX with atomoxetine resulted in an estimate of an incremental cost-effectiveness ratio of A 1802 pound 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 A 20,000 pound per QALY, LDX versus atomoxetine had an 86 % probability of being cost effective. In 38 % of PSA runs, LDX was more effective and less costly than atomoxetine.From the perspective of the UK NHS, LDX provides a cost-effective treatment option for children and adolescents who are inadequate responders to methylphenidate.