Cost–utility Analysis of Lisdexamfetamine Dimesylate in the Treatment of Adults with Attention-deficit/hyperactivity Disorder in the United Kingdom

Abstract

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioural disorder with considerable costs. Lisdexamfetamine dimesylate (LDX) is approved in the UK for ADHD treatment in children and adolescents.

Objectives

To perform an economic analysis of LDX for adults with ADHD from the UK National Health Service (NHS) perspective.

Aims

To estimate cost-effectiveness of LDX compared with methylphenidate (MPH) and atomoxetine (ATX).

Methods

A 1-year decision-analytic model was developed. Health events included response, non-response and unable to tolerate. Efficacy data were taken from a mixed-treatment comparison (MTC) analysis of all clinical trials. Response was defined as a score of 1 or 2 on the Clinical Global Impression–Improvement scale. Tolerability was assessed by discontinuation rates due to adverse events. Utility weights were identified via a systematic literature review. Healthcare resource use estimates were obtained via a survey of clinicians. Daily drug costs were based on mean doses reported in the trials used in the MTC. One-way and probabilistic sensitivity analyses were performed.

Results

The comparison of LDX and MPH for 100 people resulted in an increased annual cost of £34 and quality-adjusted life-years (QALYs) of 0.5, with an incremental cost-effectiveness ratio of £64 per QALY. When compared with ATX for 100 people, LDX was a dominant strategy, with lower annual costs (–£26,700) and higher QALYs (1.0). There was a 62% probability of LDX being cost-effective versus MPH-ER at a threshold of £20,000 per QALY.

Conclusions

From the perspective of the UK NHS, LDX provides a cost-effective treatment option for adults with ADHD.