BackgroundEconomic evaluations of treatments for children with behavioural difficulties (i.e., characteristics of attention‐deficit/hyperactivity disorder (ADHD) and/or oppositional defiant disorder (ODD)) usually rely on data of randomised controlled trials or are model‐based. Findings of such studies may not be representative of cost‐effectiveness and cost‐utility in clinical practice. The current longitudinal study aimed to perform an economic evaluation of treatments for children with hyperactivity, impulsive behaviours, inattention, and/or behavioural difficulties using observational data that were obtained in clinical practice.MethodsParents of 209 children (aged 5–12) who were referred to 1 of 10 Dutch youth mental healthcare institutions and who received treatment with (n = 108) or without (n = 101) the use of medication, filled out questionnaires at three timepoints (baseline, and ~ 6 and ~12 months later). Propensity score matching was used to make both groups comparable. Outcomes included quality‐adjusted life years (QALYs), ADHD and ODD symptom severity, and impairment. Costs were measured from a societal perspective. Incremental cost‐effectiveness ratios (ICERs) were estimated, and cost‐effectiveness acceptability curves (CEACs) were derived to show uncertainty around the ICER.ResultsResults did not show statistically significant differences in costs and effects between children who were treated with medication (alone or in combination with non‐medication treatment) and those who were treated without medication. CEAC suggested that medication treatment has a 55% probability of being cost‐effective at the €80,000 threshold and 36% at the €20,000 threshold compared with treatment without medication.ConclusionsUsing observational data, our study did not provide clear evidence of the cost‐effectiveness and cost‐utility of treatment with medication compared with treatment without medication in clinical practice.

中文翻译：

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临床实践中行为困难儿童的药物治疗与不药物治疗：观察数据的经济评估


背景对行为困难儿童（即注意力缺陷/多动障碍（ADHD）和/或对立违抗障碍（ODD）的特征）治疗的经济评估通常依赖于随机对照试验的数据或基于模型。此类研究的结果可能不能代表临床实践中的成本效益和成本效用。当前的纵向研究旨在利用临床实践中获得的观察数据对多动、冲动行为、注意力不集中和/或行为困难儿童的治疗进行经济评估。方法 209 名被转介的儿童（5-12 岁）的父母荷兰 10 家青少年心理保健机构中的 1 家接受药物治疗（n = 108）或未接受药物治疗（n = 101）的人在三个时间点（基线、约 6 个月和约 12 个月后）填写了调查问卷。使用倾向评分匹配来使两组具有可比性。结果包括质量调整生命年 (QALY)、ADHD 和 ODD 症状严重程度以及损伤。成本是从社会角度衡量的。估计了增量成本效益比（ICER），并得出了成本效益可接受性曲线（CEAC）以显示 ICER 的不确定性。 结果结果没有显示接受药物治疗（单独或与非药物治疗相结合）和未接受药物治疗的患者。 CEAC 建议，与不使用药物治疗相比，在 80,000 欧元门槛下，药物治疗具有成本效益的可能性为 55%，在 20,000 欧元门槛下，药物治疗具有成本效益的可能性为 36%。结论使用观察数据，我们的研究没有提供明确的证据来证明临床实践中药物治疗与不药物治疗相比的成本效益和成本效用。