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

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Clinical effectiveness
examined MPH administered once daily and one
examined MPH given two or more times daily.
Only Kupietz and colleagues 71 evaluated
hyperactivity as an outcome measure using the
CTRS (Table 23). In this parallel study, the nondrug
intervention involved a one-to-one reading
therapy programme during weeks 3–14 and weeks
16–27 of the study. While the results of these
analyses are not clearly reported, the MD and 95%
CI values show significant differences in favour of
combined treatment.
Pelham and colleagues 81 did not report on
hyperactivity or QoL outcomes, but did assess
inattention/overactivity (using the IOWA Conners’
Rating Scale as assessed by teachers and parents),
and also other core outcomes (see Appendix 12).
They reported that once-daily low-dose MPH (plus
non-drug intervention) was better for
inattention/overactivity than non-drug
intervention (p < 0.05).
Brown and colleagues 41 examined MPH plus
cognitive training compared with cognitive
training alone. Outcome measures assessed
included the CPRS and the Abbreviated CTRS. It
appears that MPH plus cognitive training was
more beneficial than cognitive training alone,
although the significance of these comparisons was
not clear.
Adverse events
One study presented data on adverse events. 81
Incidence of headache, stomach ache, insomnia
and appetite loss did not differ significantly
between treatment groups. Data on weight were
not reported.
Summary
Only one study examined hyperactivity as an
outcome measure, 71 with significant results in
favour of combined treatment. No studies
examined CGI. Another study examined adverse
events, 81 but reported no differences between the
treatment groups. The studies did not score very
well in the quality assessment, and any results
should be interpreted with caution.
MPH medium dose (15–30 mg/day) plus non-drug
intervention versus non-drug intervention
Eleven studies evaluated medium-dose
(15–30 mg/day) immediate-release MPH plus nondrug
intervention compared with a non-drug
intervention (Table 24; with additional information
in Appendix 12). One of the studies examined
medium-dose MPH administered once daily and
10 examined MPH administered two or more
times daily.
Hyperactivity
Three studies reported on hyperactivity as an
outcome, all of which used a Conners’ scale
(Table 25). 42,53,71 Brown and colleagues 42 also
evaluated hyperactivity using the ACTeRS.
Although all were parallel studies, the different
types of Conners’ scales (two reported results for
teachers and one reported result for parents) and
the lack of detailed statistical information
precluded the studies from being combined in a
meta-analysis.
Firestone and colleagues 53 reported that MPH
plus parent training was superior to parent
training alone. Similarly, Kupietz and colleagues 71
reported that MPH plus one-to-one reading
therapy was significantly better than one-to-one
therapy without medication. Brown and
colleagues 42 did not present clear results for
comparisons between MPH plus cognitive therapy
compared with cognitive therapy; however, the
MD and 95% CI values demonstrate significant
differences in favour of combined treatment.
Two of the remaining eight studies measured
overall behaviour using the Abbreviated CTRS, 77,78
and six evaluated inattention/overactivity using a
IOWA Rating Scale. 69,79–82,88 A number of these
studies were conducted by Pelham and colleagues
and involved behaviour modification that took
place over a Summer Treatment Programme
(STP). 77–81 The results from direct comparisons
between treatment groups were not always clearly
presented in these studies (see Appendix 12 for
more detail). One study by Pelham and colleagues 82
was conducted at home and in a Saturday school.
In this study, MPH plus a behavioural programme
was significantly better than the behavioural
programme alone (p < 0.001).
Similarly, Smith and colleagues 88 evaluated
medium-dose MPH plus behavioural treatment
compared with behavioural treatment alone. They
reported that a significant difference was observed
between all comparisons at the p < 0.05 level, but
no further detail was given. Lastly, in the study by
Kolko and colleagues, 69 medium-dose MPH plus
behaviour modification was reported to be better
for scores on inattention/overactivity than
behaviour modification alone (see Appendix 12).
Quality of life
No studies reported data on CGI. Pelham and
colleagues 82 assessed global effectiveness as