Cost-Effectiveness of Treatment Options for ADHD: A Systematic Literature Review

Backround: Interest in cost-effective Attention Deficit Hyperactivity Disorder (ADHD) treatment is rising, and the reduction of costs is important due to increasing health care expenditures. Treatment strategies for ADHD patients consist of medication, behavioral treatment, and combined treatment and have to be compared regarding cost-effectiveness to enable reliable decisions on appropriate treatment. Objective: The objective is to present evidence on cost-effectiveness of ADHD treatment strategies and to discuss the potential for economic optimization from an international perspective. Methods: A literature review was conducted within the German Institute of Medical Documentation and Information (DIMDI) literature database and presented according to the PRISMA scheme. Inclusion criteria consist of costeffectiveness and the potential for cost reduction by treatment. Results: While there is evidence for the cost-effectiveness of pharmacotherapies, there is less information regarding the cost-effectiveness of other treatment options, such as behavioral treatment. Medication is cost-effective according to the international threshold values. Atomoxetine, dextroamphetamine and guanfacine represent an alternative or supplement treatment to methylphenidate depending on patient characteristics. Discussion: There is only small evidence for the cost-effectiveness of multimodal treatment for ADHD patients worldwide. Cost factors such as comorbidities, hospitalization and compliance have to be considered in addition for the choice of therapy. Conclusion: The cost-effectiveness of ADHD medications is well documented, whereas studies on the behavioral measures and multimodal therapy are lacking. There is an urgent need for evaluation, especially, because the multimodal therapy is defined as an important element treatment by experts and guidelines.