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

TABLE 70 Data for weighted average daily dose in the cost–utility model submitted by Janssen-Cilag
The follow-up consultations and monitoring tests
include those resulting from adverse events. The
costs were inflated to 2003 values using the
inflation rate for hospital and community health
services in the UK. 135 For the purpose of the
model, it was assumed that 50% of patients had
co-morbidities. The cost of a patient discontinuing
all therapy was assumed to be equal to that of a
non-responder to behavioural therapy.
The unit costs of the pharmacotherapy were based
on published sources for those treatments
available in the UK. 29 The cost per milligram of
each of the drugs is £0.019 for DEX and IR-MPH,
£0.050 for 18-mg tablets of Concerta XL and
£0.034 for 36-mg tablets of Concerta XL.
[Confidential information removed].
The dosing schedules considered are shown in
Table 70.
[Confidential information removed].
The price of Equasym XL was not available for the
UK, so it was assumed to be £1 per day, which was
Health Technology Assessment 2006; Vol. 10: No. 23
Dosing IR-MPH or DEX Nearest equivalent dose Concerta XL Patients continue on dose (%)
TABLE 71 Annual costs of pharmacotherapy used in the
cost–utility model submitted by Janssen-Cilag
Drug Annual cost (£)
DEX 112
IR-MPH 110
Concerta XL 381
Equasym XL 317
ATX 914
[Confidential information removed]
TABLE 72 Cost-effectiveness results from the model submitted by Janssen-Cilag
© Queen’s Printer and Controller of HMSO 2006. All rights reserved.
entered into the model as 0.8 times the weighted
average cost of Concerta XL. The annual costs of
each drug are shown in Table 71.
Summary of utility data
The utility data were based on a previously
published poster 136 that obtained UK-based EQ-
5D scores elicited from parents acting as proxies
for their children with ADHD. The utility values
were 0.837 for responders, and 0.773 for nonresponders,
regardless of treatment type.
[Confidential information removed].
Summary of cost-effectiveness
The results from the deterministic model are
shown in Table 72. First-line Equasym XL, BT and
ATX were all found to be dominated by Concerta
XL. A treatment dominates an alternative when it
is less costly and more effective. The cost per
QALY gained with Concerta XL compared with
IR-MPH is well within the commonly used values
of willingness to pay for a QALY.
[Confidential information removed].
The data used for the probabilistic analysis are
shown in Tables 73 and 74.
The CIs around the non-drug resource use are
relatively wide. It is not clear, either from the
submission or the previous publication, whether
these estimates represent first- or second-order
uncertainty. One would expect first-order
uncertainty to be greater than second-order
uncertainty, which may explain the width of the
CIs, but this would mean that the uncertainty in
the model results is slightly overestimated.
First-line treatment Cost per patient £) QALYs per patient ICER
IR-MPH –
Concerta XL 4992
Equasym XL [Confidential information removed] D
ATX D
BT D
89