European Child & Adolescent Psychiatry

, Volume 16, Issue 7, pp 421–429 | Cite as

Long-acting medications for the hyperkinetic disorders

A note on cost-effectiveness
  • Michael Schlander


New long-acting medications for attention-deficit/hyperactivity disorder (ADHD) have become available, which combine certain advantages over conventional short-acting drugs with higher acquisition costs. Choices between these drugs should thus be driven by their clinical profiles and by an acceptable balance of increased costs and additional benefits. Accordingly, the notion of relative cost-effectiveness should be central to recommendations about the use of these drugs in practice. A recent technology assessment on behalf of the National Institute for Health and Clinical Excellence (NICE) did not identify differences between compounds in terms of clinical efficacy and described drug cost as the major driver of cost-effectiveness. The underlying economic model was restricted to a cost-utility analysis that used only a fraction of the available clinical evidence base and did not address the distinction between efficacy and effectiveness. Cost-effectiveness evaluations including the potential impact of improved treatment compliance indicate a relatively more attractive cost-effectiveness of long-acting medications than suggested by the NICE assessment. These evaluations provide health economic support to treatment recommendations recently published by the European Network for Hyperkinetic Disorders. Limitations of currently available economic evaluations include their short time horizon, and future research should assess treatment effects on long-term sequelae associated with ADHD.


attention deficit-hyperactivity disorder (ADHD) hyperkinetic disorder (HKD) stimulants methylphenidate atomoxetine cost-effectiveness 


Conflicts of interset

There was no third-party or industry involvement in the present paper. The Institute for Innovation & Valuation in Health Care (InnoVal-HC) is a not-for-profit research organization formally associated with the University of Applied Economic Sciences Ludwigshafen (Germany); the Institute accepts support under a policy of unrestricted educational grants only. Potential competing interests: The Institute and/or its staff report having received public speaking and conference attendance as well as project support from payers’, physicians’, and pharmacists’ associations, as well as from companies including E. Lilly and Johnson & Johnson.


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Copyright information

© Steinkopff Verlag 2007

Authors and Affiliations

  1. 1.Institute for Innovation & Valuation in Health Care (INNOVALHC)EschbornGermany
  2. 2.University of Applied Economic Sciences LudwigshafenLudwigshafenGermany
  3. 3.Dept. of Public Health, Social and Preventive Medicine, Mannheim Medical FacultyUniversity of HeidelbergHeidelbergGermany

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