COMORBIDITY AS A MODERATOR OF COSTEFFECTIVENESS

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COMORBIDITY AS A MODERATOR OF COST-EFFECTIVENESS
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• Cost-Effectiveness of ADHD Treatments Findings
  from the MTA Study
• Peter S. Jensen, M.D.,
• Joe Albert Garcia, Ph.D.,
• Sherry Glied, Ph.D.,
• Maura Crowe, B.A.,
• E. Michael Foster, Ph.D.,
• Michael Schlander, M.D.,
• Stephen Hinshaw, Ph.D.,
• Benedetto Vitiello, M.D.,
• L. Eugene Arnold, M.D.,
• Glen Elliott, M.D.,
• Lily Hechtman, M.D.,
• Jeffrey H. Newcorn, M.D.,
• William E. Pelham, Ph.D.,
• James Swanson, Ph.D.,
• Karen Wells, Ph.D.

• The Cost-Effectiveness of Treatment for ADHD
  Variation by Comorbidity
• Foster, Jensen among others

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Outline

• Brief Review of MTA
• Study Design
• Prior Findings
• CEAround 1
• CEACa better alternative
• CEACround 2
• What should a policy makers WTP be?

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Brief Review of MTA--Design

• 6 sites
• 579 Children ages 7-10
• Randomization
• Co-morbidities common

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Comorbidity
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Brief Review of MTA--Design

• Four arms
• Community care (CC)
• Medication management (MM)
• Intensive behavioral treatment (Beh)
• Combination (Comb)
• 14 months of treatment
• Wide range of outcomes across multiple domains
  and respondents

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Brief Review of MTAInitial Findings

• Participants in all groups improved
• Core symptoms Comb, MM gt Beh or CC
• Broader outcomes Comb gt MM
• Significant moderation by comorbidity status

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Rates of Normalization
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Brief Review of MTAInitial Findings

• Participants in all groups improved
• Core symptoms Comb, MM gt Beh or CC
• Broader outcomes Comb gt MM
• Significant moderation by comorbidity status

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CEA Round 1

• Costs were measured according to economic
  principles

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X
15,993
55,253
68,128
360
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But, we should note

• Comorbid children differ in other ways, and
• Other factors may serve as moderators.

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What Might a Policy Maker Be Willing to Pay to
Avert a Case of Mental Disorder?

• More likely to
• use health and mental health services
• become involved in juvenile justice system
• be treated in an emergency room
• be involved in a traffic accident
• Because ADD is a chronic condition, these costs
  mount over time.

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Conclusion

• Comorbidity moderates the cost-effectiveness of
  alternative treatments
• More generally, more complex cases benefit from
  more complex treatments
• Societys WTP for better care is high
• Next steps.