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

TABLE 19 Results for hyperactivity [MPH medium dose (15–30 mg/day) versus non-drug intervention]
MPH group and those receiving cognitive therapy
were not clearly presented; however, calculated
MD and 95% CI values demonstrate significant
differences.
The two remaining studies measured
inattention/overactivity using the IOWA CTRS as a
main outcome variable. 69,79 However, direct
statistical comparisons between medium-dose
MPH and behaviour modification were not clearly
presented (see Appendix 12).
Adverse events
No study reported adequate data on adverse
events.
Summary
Both studies that compared medium-dose MPH
(with either parent training or cognitive therapy)
demonstrated a significant difference in favour of
MPH. None of the studies examined CGI. The
studies did not score very well in the quality
assessment, and the results should be interpreted
with caution.
MPH high dose (>30 mg/day) versus non-drug
intervention
Three studies examined high-dose (>30 mg/day)
immediate-release MPH compared with a nondrug
intervention (Table 20; with additional
information presented in Appendix 12). All
studies examined MPH administered two or more
times daily.
The two other studies measured
inattention/overactivity using the IOWA CTRS as a
main outcome variable. 69,79 Statistical significance
of comparisons between high-dose MPH
compared with behaviour modification was not
reported in these studies (see Appendix 12).
Health Technology Assessment 2006; Vol. 10: No. 23
Study Scale MPH medium dose: Non-drug: Mean
mean (SD) mean (SD) difference
5–9 years
Firestone, 1986 53 MD (95% CI)
CTRS (Hyperactivity Index) 0.91 (0.58) 1.37 (0.57) –0.49 (–0.65 to –0.33)
5–13 years
Brown, 1986 42 MD (95% CI)
CPRS (Hyperactivity Index) 15.88 (6.36) 21.10 (5.65) –5.27 (–9.72 to –0.82)
ACTeRS (hyperactivity) 14.25 (5.60) 19.60 (2.63) –4.80 (–7.86 to –1.74)
Lower scores represent a better behavioural outcome.
CTRS, Conners’ Teacher Rating Scale; CPRS, Conners’ Parent Rating Scale; ACTeRS, ADD-H Comprehensive Teachers’
Rating Scale.
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One study measured hyperactivity using three
different measures (Table 21). Klein and Abikoff 65
compared high-dose MPH with a behavioural
therapy that involved parent and teacher
education. They observed that the behaviour of
the children was better in the MPH group
compared with non-drug therapy when evaluated
using the CTRS, but not when evaluated by
parents using either the CPRS or the Home
Hyperactivity Scale. However, when the MD and
CIs are calculated, these results are significant.
In addition, Klein and Abikoff 65 assessed CGI.
When evaluated by psychiatrists, 79% in the MPH
group compared with 50% in the non-drug group
improved after 8 weeks of treatment.
Adverse events
No study reported adequate data on adverse
events.
Summary
Only one study examined high-dose MPH
compared with a non-drug intervention (parent
and teacher education) using hyperactivity as an
outcome, 65 with significant effects in favour of the
drug treatment group. This study also examined
CGI, and found a higher percentage of improved
children in the MPH group compared with the
non-drug intervention group. This study did not
score very well in the quality assessment, and the
results should be interpreted with caution.
MPH low dose (15 mg/day) plus non-drug
intervention versus non-drug intervention
Three studies examined low-dose (≤15 mg/day)
immediate-release MPH plus non-drug
intervention compared with a non-drug
intervention (Table 22; with additional information
presented in Appendix 12). Two studies
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