Cost-Effectiveness and Cost Utility of Treatment of Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Objectives: This systematic review provides an overview of full economic evaluations of attention-deficit/hyperactivity disorder (ADHD) treatments, evaluates their outcomes, and highlights gaps in the literature. Data Sources: Electronic databases were searched for full economic evaluations of ADHD treatments for children, adolescents, or adults published in English or Dutch. Results: Twenty-nine studies met the inclusion criteria. Almost all studies that compared medication or psychosocial treatment to no treatment, placebo, or care as usual indicated that medication and psychosocial treatment were cost-effective compared to the control group. Stimulant treatment appeared to be cost-effective for the treatment of ADHD in children and adolescents. Only few studies focus on treatments in adults and psychosocial treatments and the number of studies with long time horizons and without industry funding is limited. Conclusions: Despite the rising interest in cost-effectiveness, this systematic review shows that more cost-effectiveness research of higher quality is warranted to aid in the optimal use of available treatments and resources for individuals with ADHD. Specifically, more studies should focus on treatments in adults and psychosocial treatments, and more studies with long time horizons and without industry funding are warranted. Nevertheless, we can conclude that treating ADHD is generally cost-effective compared to no treatment. PROSPERO: CRD42017060074. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=60074.

EDTA-plasma vs serum differences in cholesterol, high-density-lipoprotein cholesterol, and triglyceride as measured by several methods

To investigate EDTA-plasma/serum (P/S) differences, we collected paired samples from 25 volunteers and measured total cholesterol (TC), triglyceride (TG) and high-density-lipoprotein cholesterol (HDLC), using the Cobas FARA, Ektachem 700, DuPont Dimension, and Baxter Paramax Analyzers. The mean (SD) P/S ratios for TC, HDLC, and TG concentrations were, respectively: 0.980 (0.0171), 1.063 (0.0704), and 0.961 (0.363) for Paramax; 0.976 (0.0189), 1.034 (0.1091), and 0.950 (0.557) for Dimension; 1.003 (0.0221), 1.059 (0.0304), and 0.988 (0.0179) for Ektachem; and 0.993 (0.0162), 1.063 (0.0830), and 1.013 (0.0410) for Cobas. We conclude that P/S ratios vary by analytical methods, and that HDLC ratios tend to be larger in magnitude and in the opposite direction from TC and TG. Both effects lead to significant biases in computed disease risk.

EDTA-plasma vs serum differences in cholesterol, high-density-lipoprotein cholesterol, and triglyceride as measured by several methods

To investigate EDTA-plasma/serum (P/S) differences, we collected paired samples from 25 volunteers and measured total cholesterol (TC), triglyceride (TG) and high-density-lipoprotein cholesterol (HDLC), using the Cobas FARA, Ektachem 700, DuPont Dimension, and Baxter Paramax Analyzers. The mean (SD) P/S ratios for TC, HDLC, and TG concentrations were, respectively: 0.980 (0.0171), 1.063 (0.0704), and 0.961 (0.363) for Paramax; 0.976 (0.0189), 1.034 (0.1091), and 0.950 (0.557) for Dimension; 1.003 (0.0221), 1.059 (0.0304), and 0.988 (0.0179) for Ektachem; and 0.993 (0.0162), 1.063 (0.0830), and 1.013 (0.0410) for Cobas. We conclude that P/S ratios vary by analytical methods, and that HDLC ratios tend to be larger in magnitude and in the opposite direction from TC and TG. Both effects lead to significant biases in computed disease risk.

Discrepancies between sodium concentrations measured by the Kodak Ektachem 700 and by dilutional and direct ion-selective electrode analyzers

We have identified rare (approximately 0.2% of all samples), but clinically significant, discrepancies between serum or plasma sodium concentrations measured with the Kodak Ektachem 700's direct ion-selective electrode (ISE) method and concentrations measured with two other analyzers: the Beckman Synchron CX3's dilutional ISE instrument and the Radiometer KNA2 instrument for sodium-potassium analysis by the direct ISE method. The differences do not appear to be related to any previously identified sources of discrepancy, such as variations in triglycerides, bicarbonate, total protein, albumin, or gamma-globulin, the presence of paraproteins, or interference by benzalkonium chloride from heparinized catheters. They occurred despite the use of Gen 04 reference fluid on the Ektachem. We could not identify any drug or family of drugs that the patients had taken in common and that might influence the results. Until this problem is resolved, Ektachem users should be aware of the potential for discrepancies of > 6 mmol/L in measurements of sodium concentrations.

Discrepancies Between Sodium Concentrations Measured by the Kodak Ektachem 700 and by Dilutional and Direct Ion-Selective Electrode Analyzers

We have identified rare (approximately 0.2% of all samples), but clinically significant, discrepancies between serum or plasma sodium concentrations measured with the Kodak Ektachem 700's direct ion-selective electrode (ISE) method and concentrations measured with two other analyzers: the Beckman Synchron CX3's dilutional ISE instrument and the Radiometer KNA2 instrument for sodium-potassium analysis by the direct ISE method. The differences do not appear to be related to any previously identified sources of discrepancy, such as variations in triglycerides, bicarbonate, total protein, albumin, or gamma-globulin, the presence of paraproteins, or interference by benzalkonium chloride from heparinized catheters. They occurred despite the use of Gen 04 reference fluid on the Ektachem. We could not identify any drug or family of drugs that the patients had taken in common and that might influence the results. Until this problem is resolved, Ektachem users should be aware of the potential for discrepancies of > 6 mmol/L in measurements of sodium concentrations.