APPENDICES. A systematic review and economic model of the ...

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182 Appendix 7 Appropriateness of method of dealing with No uncertainty around cost-effectiveness? Sensitivity analysis? Multi-way sensitivity analysis was conducted to test the robustness of the findings to response rates, changes in QoL and costs. The sensitivity analysis suggested a range of £4691–28,191 per QALY gained Modelling inputs and techniques appropriate? No Authors’ conclusions MPH is of reasonable cost-effectiveness when considering short-term and long-term benefits with an estimated cost per QALY of £7446–9177 Lord and Paisley, 2000 4 data extraction form Authors Lord and Paisley Date 2000 Type of economic evaluation Cost-effectiveness analysis Currency used £ Years to which costs apply 1999 Perspective NHS Study population Children Intervention 1 Combined therapy (IR-MPH) and BT Intervention 2 BT Source of effectiveness data Meta-analysis of MTA SNAP hyperactivity/impulsiveness index results Clinical outcomes measured and methods of valuation used SNAP hyperactivity/impulsiveness index results based on teacher report Cost data handled appropriately? Yes, unit costs were reported separately from resource use Modelling summary Not undertaken Outcome measures used in economic evaluations SNAP-IV Direction of result with appropriate quadrant location North-east when comparing combination therapy with BT Statistical analysis for patient-level stochastic data? No Appropriateness of statistical analysis? Appropriate Uncertainty around cost-effectiveness expressed Yes Appropriateness of method of dealing with uncertainty around cost-effectiveness? OK Sensitivity analysis? Two-way sensitivity analyses varying costs and effects. Assumptions not tested Modelling inputs and techniques appropriate? No Authors’ conclusions The best estimate of the ICER for combined therapy compared with behavioural therapy was about £1600 per one SD in the SNAP hyperactivity/impulsiveness index
Zupancic and colleagues 1998 126 data extraction form © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 23 Authors Zupancic et al. Canadian Coordinating Office of Health Technology Assessment (CCOHTA). Shukla and Otten 127 conducted a technology overview based on this work (CCOHTA) Date 1998 Type of economic evaluation Cost-effectiveness analysis Currency used Can$ Years to which costs apply 1997 Perspective Third-party payers (public and private) Study population Children 0–18 years with a diagnosis of ADD, ADD-H or ADHD Intervention 1 MPH Intervention 2 DEX Intervention 3 BT Intervention 4 Combined therapy (BT and MPH) Intervention 5 No treatment was used as the initial treatment comparator Intervention 6 PEM (low dose, high dose). Results were calculated both including and excluding pemoline. The report below is based on their analysis excluding pemoline as this is of most relevance in the UK Source of effectiveness data A meta-analysis using various behavioural rating scales including the Abbreviated CTRS Clinical outcomes measured and methods of Treatment outcomes were expressed in mean scores of various valuation used behavioural rating scales as completed by parents or teachers Cost data handled appropriately? Direct costs included medication, physician visits and hospitalisation. Information on typical resource use was obtained from three expert panels. Patients on MPH were assumed to have two specialist visits and four GP visits over 1 year along with two complete blood count tests (at baseline and 1 year). Patients on DEX were assumed to have two specialist visits and three GP visits. Patients on BT were assumed to have 16 hours of child counselling, 8 hours of parent training and 2 hours of teacher training. Patients receiving combined therapy received MPH and BT. Patients not receiving any treatment were assumed to have four extra visits to their GP per year. Costs of severe side-effects were included but not mild and moderate Modelling summary A decision-analytic model was used based on a decision tree Outcome measures used in economic evaluations The magnitude of clinical effects was estimated from a CCOHTA metaanalysis using the CTRS. Economic outcomes were expressed as the weighted mean difference in CTRS. A six-point change on the CTRS is approximately one SD and was thought to be a ‘clinically relevant’ effect size. Based on a survey of treatment practice in British Columbia, they estimated 35% of children started on MPH would continue to be treated at 6 months and 15% at 1 year Direction of result with appropriate quadrant In the analysis excluding PEM, MPH was found to be the most costlocation effective treatment, the result being located in the north-east quadrant Statistical analysis for patient-level stochastic data? No Appropriateness of statistical analysis? Yes Uncertainty around cost-effectiveness expressed? Yes Appropriateness of method of dealing with Appropriate uncertainty around cost-effectiveness? continued 183
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366 Appendix 13 Study characteristi
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