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

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Appendix 7
Sensitivity analysis? Extensive one-way sensitivity analyses were undertaken. The use of a
generic band of MPH, worst case analysis, change in physician and
psychologist fees, compliance and lower or higher body weight for drug
dose calculation were tested but these did not alter the conclusions
Modelling inputs and techniques appropriate? Yes
Authors’ conclusions The ICER of MPH compared with no treatment was Can$64 for every
point gained on the CTRS or Can$386 for a six-point gain, that is, one
SD
Marchetti and colleagues, 2001 128 data extraction form
Authors Marchott, et al.
Date 2001
Type of economic evaluation Total expected cost analysis
Currency used Can$
Years to which costs apply 2001
Perspective Third-party payer (although in-school costs are calculated also)
Study population Children and/or adolescents with ADHD with no co-morbidities
Intervention 1 MPH IR/ER
Intervention 2 MPH IR
Intervention 3 Metadate CD (branded IR/ER MPH)
Intervention 4 Concerta (branded ER MPH)
Intervention 5 Ritalin (branded IR MPH)
Intervention 6
in the UK
Adderall (a combination of DEX and amphetamine salts) – not licensed
Source of effectiveness data Response rates based on pooled estimates from the literature and on
author assumption
Clinical outcomes measured and methods of
valuation used
As above only
Cost data handled appropriately? Direct costs included medication, office visits (physician, psychiatrist
and psychologist) and laboratory tests. Human and material resources
associated with ADHD care were estimated based on a survey and
national and published data. Additionally, time spent by school
personnel on administering in-school drug doses was included from a
sample of four schools
Modelling summary Effect sizes were combined across studies using a random effects
model. Information from the clinical assessment and meta-analysis were
used to populate a decision-analytic model to compute total expected
cost for each comparator
Outcome measures used in economic evaluations Response rates used to calculate the cost of pathways of care
Direction of result with appropriate quadrant Not applicable as not compared with relative effects. Metadate CD had
location the lowest total expected cost relative to the other five interventions
assessed
Statistical analysis for patient-level stochastic data? Not undertaken
Appropriateness of statistical analysis The approach to estimating the response rate for each comparator was
unusual in the sense that the results of different outcome measures to
assess response rate were pooled
Uncertainty around cost-effectiveness expressed Not undertaken
continued