Treatments with versus without medication for children with behavioural difficulties in clinical practice: an economic evaluation with observational data.

IF 6.5 1区医学 Q1 PSYCHIATRY Journal of Child Psychology and Psychiatry Pub Date : 2024-09-30 DOI:10.1111/jcpp.14057

Caitlin K Kiernan, Hermien H Dijk, Barbara J van den Hoofdakker, Pieter J Hoekstra, Annabeth P Groenman

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Abstract

Background: Economic 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.

Methods: Parents 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.

Results: Results 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.

Conclusions: Using 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.

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临床实践中对有行为障碍的儿童采用药物治疗与不采用药物治疗的对比：利用观察数据进行经济评估。

背景：针对儿童行为障碍（即注意力缺陷/多动障碍和/或对立违抗障碍的特征）的治疗方法的经济评估通常依赖于随机对照试验的数据或基于模型的数据。此类研究的结果可能无法代表临床实践中的成本效益和成本效用。本纵向研究旨在利用临床实践中获得的观察数据，对多动症、冲动行为、注意力不集中和/或行为障碍儿童的治疗方法进行经济评估：方法：209 名儿童（5-12 岁）的家长在三个时间点（基线、约 6 个月和约 12 个月后）填写了调查问卷，这些儿童被转介到荷兰 10 家青少年心理医疗机构中的一家，接受了药物治疗（108 人）或未接受药物治疗（101 人）。为使两组具有可比性，采用了倾向得分匹配法。研究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程度。成本从社会角度进行衡量。估算了增量成本效益比（ICER），并绘制了成本效益可接受性曲线（CEAC），以显示ICER周围的不确定性：结果表明，接受药物治疗（单独或与非药物治疗相结合）的儿童与不接受药物治疗的儿童在成本和效果上没有明显的统计学差异。CEAC 认为，与不用药治疗相比，用药治疗在 8 万欧元阈值下具有成本效益的概率为 55%，在 2 万欧元阈值下为 36%：通过观察数据，我们的研究并未提供临床实践中用药治疗与不用药治疗的成本效益和成本效用的明确证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Child Psychology and Psychiatry 医学-精神病学

CiteScore

13.80

自引率

5.30%

发文量

169

审稿时长

1 months

期刊介绍： The Journal of Child Psychology and Psychiatry (JCPP) is a highly regarded international publication that focuses on the fields of child and adolescent psychology and psychiatry. It is recognized for publishing top-tier, clinically relevant research across various disciplines related to these areas. JCPP has a broad global readership and covers a diverse range of topics, including: Epidemiology: Studies on the prevalence and distribution of mental health issues in children and adolescents. Diagnosis: Research on the identification and classification of childhood disorders. Treatments: Psychotherapeutic and psychopharmacological interventions for child and adolescent mental health. Behavior and Cognition: Studies on the behavioral and cognitive aspects of childhood disorders. Neuroscience and Neurobiology: Research on the neural and biological underpinnings of child mental health. Genetics: Genetic factors contributing to the development of childhood disorders. JCPP serves as a platform for integrating empirical research, clinical studies, and high-quality reviews from diverse perspectives, theoretical viewpoints, and disciplines. This interdisciplinary approach is a key feature of the journal, as it fosters a comprehensive understanding of child and adolescent mental health. The Journal of Child Psychology and Psychiatry is published 12 times a year and is affiliated with the Association for Child and Adolescent Mental Health (ACAMH), which supports the journal's mission to advance knowledge and practice in the field of child and adolescent mental health.