Résumé
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.
Sujets)
Humains , Mâle , Femelle , Enfant , Adolescent , Trouble déficitaire de l'attention avec hyperactivité/traitement médicamenteux , Analyse coût-bénéfice , Stimulants du système nerveux central/usage thérapeutique , Méthylphénidate/usage thérapeutique , Trouble déficitaire de l'attention avec hyperactivité/économie , Brésil , Études de suivi , Chaines de Markov , Sensibilité et spécificité , Coûts des médicaments/statistiques et données numériques , Années de vie ajustées sur la qualité , Préparations à action retardée/administration et posologie , Préparations à action retardée/économie , Stimulants du système nerveux central/économie , Méthylphénidate/économieRésumé
OBJETIVE: The main objective of this study was to assess the interrater agreement for the Schedule for Affective Disorders and Schizophrenia Epidemiological version for School-Age Children (K-SADS-E). METHODS: Four interviewers being trained with the K-SADS-E scored independently 29 videotaped interviews performed with psychiatric outpatients in the ADHD Outpatient Clinic at Hospital de Clínicas de Porto Alegre. Interrater agreement analysis was performed using the kappa coefficient (k). RESULTS: Kappa coefficients were .93 (p<.001) for affective disorders, .9 (p<.001) for anxiety disorders, .94 (p<.001) for attention-deficit/hyperactivity disorders and disruptive behavior disorders. CONCLUSION: These findings suggest an excellent interrater agreement for the diagnosis of several mental disorders in childhood and adolescence by the Brazilian Portuguese version of the K-SADS-E