COST-EFFECTIVENESS OF SUSTAINED-RELEASE DEXMETHYLPHENIDATE VERSUS PROLONGED-RELEASE METHYLPHENIDATE FOR PEDIATRIC ADHD: AN ANCHORED MAIC ANALYSIS
Author(s)
Xinyue Dong, Ph.D1, Weilin Xing, MS candidate2, Zihan Xing, MS candidate2, Junming Tan, MS candidate2, Meng Jiang, MS candidate2, Zifei Fu, MS candidate2, Yan Zhang, Ph.D1, Jianzhou Yan, Ph.D2.
1School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China, 2Institute of Regulatory Science of China Pharmaceutical University, Nanjing, China.
1School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China, 2Institute of Regulatory Science of China Pharmaceutical University, Nanjing, China.
OBJECTIVES: Rising pediatric Attention-Deficit/Hyperactivity Disorder (ADHD) prevalence imposes substantial clinical and socioeconomic burdens worldwide. Newly approved in China, first generic sustained-release dexmethylphenidate (d-MPH-SR) offers potency and formulation advantages; yet its comparative pharmacoeconomic value remains unexamined. The study aims to evaluate the comparative efficacy and cost-effectiveness of d-MPH-SR versus the most prevalent stimulant, prolonged-release methylphenidate (MPH-PR), for Chinese pediatric ADHD.
METHODS: A hybrid short-term decision tree and long-term four-state Markov model simulated disease progression, quality-adjusted life-years (QALYs) and costs from healthcare system and societal perspectives. Lacking head-to-head trials, an anchored matching-adjusted indirect comparison (MAIC) integrating individual patient data (CTR20150202) and aggregate data from the Concerta study was performed to adjust for cross-trial heterogeneity and derive relative efficacy. Transition probabilities, costs and utilities were obtained from literature, public databases, clinician surveys and systematic reviews. Costs (in 2025 CNY/USD) and QALYs were discounted at 4.5% annually. Model validation, scenario and sensitivity analyses assessed robustness.
RESULTS: MAIC showed that d-MPH-SR was associated with numerically higher tolerability (2.14%, P=0.200) and response rates (4.70%, P=0.337), alongside significantly fewer adverse events than MPH-PR. In simulated patients, d-MPH-SR increased remission by 0.05 percentage points. Base-case per-patient costs were CN¥85,117 (US$11,916) for d-MPH-SR and CN¥94,699 (US$13,258) for MPH-PR, with corresponding QALYs of 6.49 and 6.48, respectively. d-MPH-SR dominated MPH-PR, generating a net monetary benefit of CN¥10,647 (US$1,491)-CN¥11,712 (US$1,640) at China’s willingness-to-pay threshold of 1-2 times per-capita GDP. Its economic advantage was greater from the societal perspective incorporating caregiver burden. Findings remained robust across all sensitivity analyses.
CONCLUSIONS: This study presents the first economic evaluation of d-MPH-SR for ADHD. Compared to MPH-PR, d-MPH-SR was demonstrated cost-effective in Chinese pediatric patients, primarily driven by favorable safety and efficacy profiles translating into improved long-term outcomes. The findings may inform healthcare resource allocation and clinical decision-making in similar resource-limited settings.
METHODS: A hybrid short-term decision tree and long-term four-state Markov model simulated disease progression, quality-adjusted life-years (QALYs) and costs from healthcare system and societal perspectives. Lacking head-to-head trials, an anchored matching-adjusted indirect comparison (MAIC) integrating individual patient data (CTR20150202) and aggregate data from the Concerta study was performed to adjust for cross-trial heterogeneity and derive relative efficacy. Transition probabilities, costs and utilities were obtained from literature, public databases, clinician surveys and systematic reviews. Costs (in 2025 CNY/USD) and QALYs were discounted at 4.5% annually. Model validation, scenario and sensitivity analyses assessed robustness.
RESULTS: MAIC showed that d-MPH-SR was associated with numerically higher tolerability (2.14%, P=0.200) and response rates (4.70%, P=0.337), alongside significantly fewer adverse events than MPH-PR. In simulated patients, d-MPH-SR increased remission by 0.05 percentage points. Base-case per-patient costs were CN¥85,117 (US$11,916) for d-MPH-SR and CN¥94,699 (US$13,258) for MPH-PR, with corresponding QALYs of 6.49 and 6.48, respectively. d-MPH-SR dominated MPH-PR, generating a net monetary benefit of CN¥10,647 (US$1,491)-CN¥11,712 (US$1,640) at China’s willingness-to-pay threshold of 1-2 times per-capita GDP. Its economic advantage was greater from the societal perspective incorporating caregiver burden. Findings remained robust across all sensitivity analyses.
CONCLUSIONS: This study presents the first economic evaluation of d-MPH-SR for ADHD. Compared to MPH-PR, d-MPH-SR was demonstrated cost-effective in Chinese pediatric patients, primarily driven by favorable safety and efficacy profiles translating into improved long-term outcomes. The findings may inform healthcare resource allocation and clinical decision-making in similar resource-limited settings.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE11
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Pediatrics