A cost-effectiveness analysis of lisdexamfetamine dimesylate in the treatment of adults with attention-deficit/hyperactivity disorder in the UK

Evelina A. Zimovetz (), Alain Joseph, Rajeev Ayyagari and Josephine A. Mauskopf
Additional contact information
Evelina A. Zimovetz: RTI Health Solutions
Alain Joseph: Shire
Rajeev Ayyagari: Analysis Group, Inc.
Josephine A. Mauskopf: RTI Health Solutions

The European Journal of Health Economics, 2018, vol. 19, issue 1, No 3, 35 pages

Abstract: Abstract Background Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder in children that may persist into adulthood. Lisdexamfetamine dimesylate (LDX) is approved in many countries for ADHD treatment in children, adolescents, and adults. Objectives Estimate the cost-effectiveness of LDX as a first- or second-line treatment for adults with ADHD from the United Kingdom (UK) National Health Service (NHS) perspective compared with methylphenidate extended release (MPH-ER) and atomoxetine (ATX). Methods A 1-year decision-analytic model was developed. Health outcomes included response, non-response and inability to tolerate. Efficacy data were obtained from a mixed-treatment comparison (MTC). Response was a score of 1 or 2 on the Clinical Global Impression–Improvement scale. Tolerability was assessed by discontinuation rates due to adverse events. Utilities were identified via a systematic literature review. Health care resource use estimates were obtained via a survey of clinicians. Daily drug costs were estimated from mean doses reported in the trials used in the MTC. One-way and probabilistic sensitivity analyses (PSAs) were performed. Results LDX dominated MPH-ER and ATX; reducing mean per-patient annual cost by £5 and £200, and increasing mean quality-adjusted life years (QALYs) by 0.005 and 0.009, respectively. In the PSA, the probability of cost-effectiveness for LDX vs. MPH-ER and ATX at a threshold of £20,000 per QALY was 61% and 80%, respectively. Conclusions From the perspective of the UK NHS, LDX is likely to provide a cost-effective treatment for adults with ADHD. This conclusion may be drawn with more certainty in comparison with ATX than with MPH-ER.

Keywords: ADHD; Lisdexamfetamine; Cost-effectiveness analysis; Economic evaluation; Attention-deficit/hyperactivity disorder; Adult (search for similar items in EconPapers)
JEL-codes: I11 (search for similar items in EconPapers)
Date: 2018
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DOI: 10.1007/s10198-016-0864-4

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