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

TABLE 96 Results of the sensitivity analysis employing alternative estimates of resource use
no treatment. Again, strategy 9 is not ruled out by
dominance or extended dominance, but the cost
per QALY gained compared with strategy 7 is
outside the range normally considered costeffective
(£5,808,184).
Sensitivity to structural assumption
regarding MPH
A major structural assumption in the model is that
a patient who has failed treatment with one
formulation of MPH would not then receive a
different formulation of the same drug. However,
if failure on IR-MPH was due to non-compliance,
or because a midday dose was simply unworkable
for the patient, ER-MPH may be a relevant
treatment option. The effect of compliance on
response rates to IR-MPH and ER-MPH is
reflected in the model. However, the model, and
the trial data, do not identify the proportion of
Health Technology Assessment 2006; Vol. 10: No. 23
Strategy Order of treatments received Cost (£) QALYs Cost per QALY (£)
(compared with)
1 IR-MPH – ATX – DEX – no treatment 1006 0.8279 D
2 ER-MPH8 – ATX – DEX – no treatment 1233 0.8273 D
3 ER-MPH12 – ATX – DEX – no treatment 1250 0.8278 D
4 ATX – IR-MPH – DEX – no treatment 1250 0.8278 D
5 ATX – ER-MPH8 – DEX – no treatment 1320 0.8277 D
6 ATX – ER-MPH12 – DEX – no treatment 1327 0.8274 D
7 IR-MPH – DEX – ATX – no treatment 920 0.8283 D
8 ER-MPH8 – DEX – ATX – no treatment 1105 0.8277 D
9 ER-MPH12 – DEX – ATX – no treatment 1190 0.8284 D
10 ATX – DEX – IR-MPH – no treatment 1242 0.8281 D
11 ATX – DEX – ER-MPH8 – no treatment 1261 0.8281 D
12 ATX – DEX – ER-MPH12 – no treatment 1259 0.8278 D
13 DEX – IR-MPH – ATX – no treatment 887 0.8288 14,939
14 DEX – ER-MPH8 – ATX – no treatment 944 0.8287 D
15 DEX – ER-MPH12 – ATX – no treatment 945 0.8286 D
16 DEX – ATX – IR-MPH – no treatment 946 0.8288 D
17 DEX– ATX – ER-MPH8 – no treatment 965 0.8288 D
18 DEX– ATX – ER-MPH12 – no treatment 963 0.8285 D
19 No treatment 48 0.7727 –
D, dominated.
TABLE 97 Cost-effectiveness of ER-MPH8, ER-MPH12, ATX and no treatment in patients for whom a midday dose of medication is
unsuitable
Strategy Order of treatments received Cost (£) QALYs Cost per QALY (£)
(compared with)
19 No treatment 1223 0.7731 –
20 ATX only 1517 0.8093 D
22 ER-MPH8 only 1360 0.8053 4251 (vs 19)
23 ER-MPH12 only 1427 0.8140 7670 (vs 22)
D, dominated.
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non-responders that fail owing to lack of
compliance. As such, this sensitivity analysis
considers a hypothetical cohort of patients for
whom a midday dose of medication is considered
unsuitable. This includes patients who have failed
on IR-MPH or DEX where the clinician can
identify that the reason for failure is non-response.
Also included are patients for whom the clinician
judges a midday dose of medication to be
unworkable.
The model is a simple comparison of ER-MPH8,
ER-MPH12 and ATX and no treatment. The
results of the analysis are shown in Table 97. They
show that in this selected patient population, ATX
is dominated by ER-MPH12. Hence in those
patients for whom a midday dose of medication is
unsuitable, through non-compliance or for other
reasons, ER-MPH12 would precede ATX in any
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