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

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Clinical effectiveness
TABLE 17 MPH low dose (≤ 15 mg/day) versus non-drug intervention
Study Design Intervention – N Age Duration Core outcomes
(years) (months)
Administered two or more times daily
Brown, 1985 41 P MPH (5–15 mg/day, b.d.) vs 6.3–11.8 6 Core: no hyp; CPRS; ACTRS
cognitive training (12 weeks, QoL: not reported
24 sessions) – 30 AE: not reported
ACTRS, Abbreviated Conners’ Teacher Rating Scale; CPRS, Conners’ Parent Rating Scale; P, Parallel trial.
TABLE 18 MPH medium dose (15–30 mg/day) versus non-drug intervention
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.) vs 5.7–13.1 3 months Core: CPRS: Hyperactivity Index;
cognitive therapy (11 weeks, ACTeRS: hyperactivity
22 sessions) – 40 AE: not reported
Firestone, 1986 53 P MPH (22.0 mg/day, b.d.) vs 5–9 3 months Core: CTRS: Hyperactivity Index
parent training (3 months) – 134 QoL: not reported
AE: not reported
Pelham, 1993 79 C (3×) MPH (16.2 mg/day, b.d.) vs 5.4–9.9 6 Core: no hyp; IOWA CTRS:
behavioural modification inattention/overactivity
intervention (STP, 8 weeks) – 31 QoL: not reported
AE: not reported
Kolko, 1999 69 C (4×) MPH (1.2 mg/kg/day, b.d.) vs 7–13 6 Core: no hyp; IOWA CTRS:
behavioural modification inattention/overactivity
(6 weeks) – 22 QoL: not reported
AE: no details reported
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.
MPH versus non-drug intervention
MPH low dose (15 mg/day) versus non-drug
intervention
Only Brown and colleagues 41 evaluated low-dose
(≤15 mg/day) immediate-release MPH compared
with a non-drug intervention (cognitive training)
(Table 17; with additional information in
Appendix 12). In this study, hyperactivity was not
evaluated, although the authors measured overall
behaviour using the CPRS and the Abbreviated
CTRS. Results from comparisons between
treatment groups were not clearly presented in
this study.
Summary
No studies in this category examined hyperactivity,
CGI or adverse events.
MPH medium dose (15–30 mg/day) versus nondrug
intervention
Four studies examined medium-dose
(15–30 mg/day) immediate-release MPH
compared with a non-drug intervention (Table 18;
with additional information presented in
Appendix 12). All studies examined MPH
administered two or more times daily.
Only two of the studies measured hyperactivity
(Table 19). Firestone and colleagues 53 observed
that medium-dose MPH was significantly better
than parent training. This involved sessions and
group meetings on child management and
learning how to cooperate efficiently with school
personnel. In the study by Brown and
colleagues, 42 results from comparisons between the