Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil

Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

Methylphenidate: prescribing patterns in a South African primary care patient population.

BACKGROUND AND OBJECTIVE: Sales figures have indicated that there has been a steady increase in the use of methylphenidate in South Africa. The primary aim of the study was to investigate the prescribing of methylphenidate (indicated for Attention Deficit Hyperactivity Disorder in children, and narcolepsy) in a South African primary care patient population. METHODS: A retrospective, exposure cohort drug utilization study was conducted in the South African private health care sector. Data were obtained from a medical aid administrator and were analysed for all patients who received one or more prescriptions for methylphenidate (N06B A04) during 2002. RESULTS AND DISCUSSION: A total of 106 patients received one or more prescriptions for methylphenidate during the year. Ninety of the 106 patients (84.9%) were under 25 years of age (average age 10.51 years, SD=3.92 years). These 90 patients were all single and the majority of them (75.6%) were males. The Lorenz curve was used to illustrate skewness in the prescribing of methylphenidate to the patient population. Patients under the age of 25 years received on average 3.46 prescriptions for methylphenidate during the year. The most common chronic diagnosis category was 'Hyperkinetic Syndrome of Childhood'. Most of the prescriptions were obtained from pharmacies, followed by dispensing doctors and rehabilitation services. CONCLUSION: The results were in agreement with a previous South African study conducted in 1996. Further studies are recommended, especially into the quality of life of patients before and after receiving methylphenidate.