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

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Clinical effectiveness TABLE 9 MPH medium dose (15–30 mg/day) plus non-drug intervention versus placebo Study Design Intervention – N Age Duration Core outcomes (years) (weeks) Administered two or more times daily Brown, 1986 42 P MPH (20.08 mg/day, b.d.) – 40 5.7–13.1 3 months Core: CPRS: Hyperactivity Index; ACTeRs: hyperactivity QoL: not reported AE: not reported. Pelham, 1993 79 C (3×) MPH (16.2 mg/day, b.d.) – 31 5.4–9.9 6 Core: no hyp; IOWA CTRS: inattention/overactivity QoL: not reported AE: not reported Kolko, 1999 69 C (4×) MPH (0.60 mg/kg/day, b.d.) – 22 7–13 6 Core: no hyp; IOWA CTRS: inattention/overactivity QoL: not reported AE: SSERS ACTeRS, ADD-H Comprehensive Teachers’ Rating Scale; C, crossover trial (number of crossovers); CPRS, Conners’ Parent Rating Scale; CTRS, Conners’ Teacher Rating Scale; P, parallel trial; SSERS, Stimulant Drug Side Effects Rating Scale. 36 TABLE 10 Results for hyperactivity [MPH medium dose (15–30 mg/day) plus non-drug intervention versus placebo] Study Scale MPH medium dose + non-drug: mean (SD) Placebo: mean (SD) Mean difference 5–13 years Brown, 1986 42 MD (95% CI) CPRS (Hyperactivity Index) 13.78 (8.14) 17.25 (7.50) –0.31 (–4.47 to 3.85) ACTeRs (hyperactivity) 19.60 (2.63) 17.50 (4.41) 0.68 (–1.89 to 3.25) Lower scores represent a better behavioural outcome. ACTeRS, ADD-H Comprehensive Teachers’ Rating Scale; CPRS, Conners’ Parent Rating Scale.
TABLE 11 MPH high dose (>30 mg/day) plus non-drug intervention versus placebo Study Design Intervention – N Age Duration Core outcomes (years) (weeks) Administered two or more times daily Pelham, 1993 79 C (3×) MPH (32 mg/day, b.d.) – 31 5.4–9.9 6 Core: no hyp; IOWA CTRS: inattention/overactivity QoL: not reported AE: not reported Kolko, 1999 69 C (4×) MPH (1.2 mg/kg/day, b.d.) – 22 7–13 6 Core: no hyp; IOWA CTRS: inattention/overactivity QoL: not reported AE: SSERS C, crossover trial (number of crossovers); CTRS. Conners’ Teacher Rating Scale; SSERS, Stimulant Drug Side Effects Rating Scale. © Queen’s Printer and Controller of HMSO 2006. All rights reserved. TABLE 12 ER-MPH low dose (≤ 20 mg/day) versus placebo Health Technology Assessment 2006; Vol. 10: No. 23 Study Design Intervention – N Age Duration Core outcomes (years) (weeks) Administered once daily Fitzpatrick, 1992 55 C (4×) Sustained-release MPH (slow-release 6.9–11.5 8 Core: Conners’ Hyperactivity Index (parents and teacher) Ritalin, SR-20) (20 mg/day, o.d.) – 19 QoL: no CGI; comments ratings (parent and teacher) AE: STESS (parents); weight Stein, 200392 C (4×) OROS MPH (Concerta) (18 mg/day, 5.9–16 4 Core: no hyp; ADHD Rating Scale IV (parents) o.d.) – 47 QoL: CGI AE: SERS (parents) C, crossover trial (number of crossovers); CGI, Clinical Global Impression; SERS, Side Effects Rating Scale; STESS, Subject’s Treatment Emergent Symptom Scale. 37
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A systematic review and economic mo
Page 3 and 4: A systematic review and economic mo
Page 5 and 6: Objectives: To assess the clinical
Page 7 and 8: Glossary and list of abbreviations
Page 9 and 10: Glossary Adverse effect An abnormal
Page 11 and 12: Glossary continued effects. Sometim
Page 13 and 14: Glossary continued point between tw
Page 15 and 16: Background Attention deficit hypera
Page 17 and 18: mean differences with 95% confidenc
Page 19: This review examines the clinical a
Page 22 and 23: 4 Background E. Symptoms should not
Page 24 and 25: 6 Background Concerta XL Concerta X
Page 26 and 27: 8 Methods for reviewing effectivene
Page 28 and 29: 10 Methods for reviewing effectiven
Page 31 and 32: Quantity and quality of research av
Page 33 and 34: TABLE 1 The quality of included stu
Page 35 and 36: TABLE 2 An overview of trials inclu
Page 37 and 38: TABLE 2 An overview of trials inclu
Page 39 and 40: TABLE 3 MPH low dose (≤15 mg/day)
Page 41 and 42: Quality of life Only one of the 12
Page 43 and 44: TABLE 5 MPH medium dose (15-30 mg/d
Page 45 and 46: Hyperactivity All nine studies that
Page 47 and 48: TABLE 6 Results for hyperactivity [
Page 49 and 50: Study Parallel trials Buitelaar 199
Page 51 and 52: TABLE 8 Results for hyperactivity [
Page 53: Study Parallel trials Gittelman-Kle
Page 57 and 58: TABLE 14 ER-MPH medium dose (20-40
Page 59 and 60: Study Crossover trials Stein 2003 S
Page 61 and 62: TABLE 19 Results for hyperactivity
Page 63 and 64: TABLE 22 MPH low dose (≤ 15 mg/da
Page 65 and 66: TABLE 24 MPH medium dose (15-30 mg/
Page 67 and 68: assessed by parents and teachers. I
Page 71 and 72: TABLE 30 DEX medium dose (10-20 mg/
Page 75 and 76: TABLE 38 DEX medium dose (10-20 mg/
Page 77 and 78: TABLE 41 DEX-SR plus non-drug inter
Page 79 and 80: Study Michelson 2001 [0.5] Michelso
Page 81 and 82: Hyperactivity Five trials (publishe
Page 83 and 84: TABLE 47 IR-MPH low-dose (≤ 15 mg
Page 85 and 86: STP. 77,78 Neither examined hyperac
Page 87 and 88: Adverse events No significant diffe
Page 89 and 90: did report that there were no signi
Page 91 and 92: Summary The one study in this categ
Page 93 and 94: showed persisting significant super
Page 95 and 96: easily rectified with dosage adjust
Page 97 and 98: Aim The aim of this chapter is to r
Page 99 and 100: only level of social disability tha
Page 101 and 102: did not include a ‘global’ HRQo
Page 103 and 104: might decrease but costs would be e
Page 105 and 106:
1st line pharmacotherapy Response,
Page 107 and 108:
TABLE 70 Data for weighted average
Page 109 and 110:
The probabilistic results were used
Page 111 and 112:
The review also uncovered a mis-ref
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TABLE 77 Results of sensitivity ana
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TABLE 80 Response a rates (%) estim
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TABLE 82 Drug costs used in the cos
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The review of the economic evidence
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Extrapolation A secondary analysis
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economic model rests on the assumpt
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TABLE 87 Data used in calculating w
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not fully probabilistic. The averag
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Probability cost-effective 1.0 0.9
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TABLE 93 Results of sensitivity ana
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Base case model Responder to MPH Re
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TABLE 96 Results of the sensitivity
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The same method for synthesising th
Page 139 and 140:
TABLE 103 Results of the economic m
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of the 64 identified in the clinica
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126 Discussion impact of active dru
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MPH, DEX and ATX improve hyperactiv
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1. National Institute for Clinical
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tutoring on the behavior and achiev
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91. Stein MA, Blondis TA, Schnitzle
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140. Hill P, Taylor E. An auditable
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189. Francis S, Fine J, Tannock R.
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235. Rhodes SM, Coghill DR, Matthew
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hyperactive boys: comparative and c
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This version of HTA monograph volum
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380 Health Technology Assessment Pr
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382 Health Technology Assessment Pr
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