What Are the Most Cost-Effective Treatments for ADHD?

What you need to know

• Both medication and behavioral treatments for ADHD are generally cost-effective compared to no treatment.
• Stimulant medications appear to be cost-effective for treating ADHD in children and adolescents.
• More research is needed on cost-effectiveness of ADHD treatments in adults and long-term outcomes.

Background on ADHD and economic evaluations

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects about 5% of children worldwide. ADHD is associated with significant costs to individuals, families, and society due to healthcare expenses, educational needs, and lost productivity. Given limited healthcare budgets, it’s important to understand which ADHD treatments provide the most benefit for their cost.

Economic evaluations compare the costs and outcomes of different treatments to determine which options are most cost-effective. These analyses help policymakers and healthcare systems allocate resources efficiently to maximize health benefits. For ADHD, economic evaluations typically compare medication, behavioral therapy, or combined treatments to no treatment or usual care.

This systematic review aimed to provide a comprehensive overview of economic evaluations of ADHD treatments for both children and adults. The researchers examined studies on cost-effectiveness and cost-utility of medications, behavioral interventions, and combination treatments.

Overview of included studies

The review included 29 studies with a total of 31 separate economic evaluations of ADHD treatments. Key characteristics of the included studies:

• 90% focused on children/adolescents, only 4 studies included adults
• 55% evaluated medication treatments, 29% behavioral treatments, 16% combination treatments
• Most studies (77%) used modeling approaches to estimate long-term outcomes
• Time horizons ranged from 6 months to 12 years
• Perspectives included healthcare, societal, and third-party payer
• Outcome measures included quality-adjusted life years (QALYs) and ADHD symptom/impairment scales

The average quality score of the studies was 69% based on standard criteria, indicating room for improvement in methodological rigor.

Key findings on cost-effectiveness

Medication treatments

The review found consistent evidence that stimulant medications are cost-effective for treating ADHD in children and adolescents compared to no treatment:

• Methylphenidate was cost-effective vs. no treatment/placebo in multiple studies
• Extended-release formulations of methylphenidate were cost-effective or cost-saving compared to immediate-release versions
• Amphetamine/dextroamphetamine was cost-effective vs. no treatment in children

For non-stimulant medications:

• Atomoxetine was cost-effective vs. no treatment for children with contraindications to stimulants
• Guanfacine as add-on to stimulants was cost-effective in children with suboptimal stimulant response
• Evidence was mixed on atomoxetine vs. stimulants - some studies found it cost-effective, others did not

There was limited evidence on medication cost-effectiveness in adults, but two studies suggested lisdexamfetamine and atomoxetine may be cost-effective options.

Behavioral treatments

Fewer studies examined behavioral treatments, but available evidence suggested:

• Parent training programs were generally cost-effective compared to no treatment/usual care for children with ADHD
• Combined parent and teacher training may be more cost-effective than parent training alone
• Mindfulness-based cognitive therapy was cost-effective for adults from a societal perspective

Some studies found behavioral treatments were not cost-effective as adjuncts to medication compared to medication alone. However, group-based behavioral therapy was cost-effective compared to atomoxetine in one analysis.

Combination treatments

A few studies evaluated combined medication and behavioral treatments:

• The large Multimodal Treatment of ADHD (MTA) study found medication management was most cost-effective in the short-term
• However, a long-term model based on MTA data suggested community care (which could include medication) was most cost-effective over 10 years
• One study found atomoxetine plus behavioral therapy was not cost-effective vs. behavioral therapy alone

Limitations and research gaps

The authors identified several important limitations in the current evidence base:

• Very few studies on cost-effectiveness of ADHD treatments in adults
• Limited long-term data on costs and outcomes beyond 1-2 years
• Most medication studies were funded by pharmaceutical companies, potentially biasing results
• Heterogeneity in methods, perspectives, and outcomes makes comparing across studies difficult
• Few studies from low/middle-income countries

They highlighted the need for more high-quality economic evaluations, particularly:

• Cost-effectiveness of ADHD treatments in adults
• Long-term outcomes of medication and behavioral treatments
• Studies without pharmaceutical industry funding
• Evaluations of psychosocial/behavioral interventions
• Research in diverse global settings

Conclusions

Despite limitations in the evidence, this comprehensive review provides valuable insights on the cost-effectiveness of ADHD treatments:

• Both medication and behavioral treatments are generally cost-effective compared to no treatment for ADHD
• Stimulant medications appear cost-effective for children/adolescents based on consistent evidence
• Parent training programs are likely cost-effective behavioral options for children
• More research is needed on adult treatments and long-term outcomes
• Higher quality economic evaluations would help inform optimal resource allocation

While treating ADHD incurs costs, appropriate interventions can provide good value and important benefits to individuals and society. Policymakers and clinicians can use this evidence to help guide treatment decisions and coverage policies. However, treatment choices should always be individualized based on patient factors and preferences.

As our understanding of ADHD and treatment options continues to evolve, ongoing economic evaluations will be crucial to ensure healthcare resources are used efficiently to improve outcomes for people with ADHD across the lifespan.