PharmacoEconomics & Outcomes News 469 - 15 Jan 2005

Paediatric news from the 7th Annual European ISPOR CongressHamburg, Germany October 2004

Several studies presented at the 7th Annual European psychosocial functioning were significantly worse forCongress of the International Society for the group with ADHD than for controls. Average directPharmacoeconomics and Outcomes News Research medical costs (excluding medication costs) were also(ISPOR), held in Hamburg, Germany in October 2004, significantly higher among ADHD patients than amongconsidered health economic issues related to paediatric controls (€274 vs €33 per patient over 3 months).individuals. The following report highlights a selection of Furthermore, mean medical costs for mothers of ADHDthese studies. patients were higher than those for mothers of controls,

although "no differences were found in cost ofCost of neuropsychiatric disorders hits productivity losses of the mothers", the investigatorshome comment.Researchers from Sweden sought to determine the

annual costs associated with neuropsychiatric disordersCost effectiveness of adjunctive therapies inin paediatric individuals.1* Their 2003 follow-up studypaediatric epilepsyinvolved 56 boys (mean age 18 years) with high-Adjunctive QALYs Per-patient Incrementalfunctioning autism or Aspergers syndrome (n = 17),therapy gained per costs (£)a cost perattention-deficit hyperactivity disorder (ADHD; 18) or

patient QALY gainedreading and writing disorder, and their families. (£)Questionnaires were used to obtain cross-sectional data

Topiramate 2.144 3469on outpatient and inpatient care for the child, andLamotrigine 2.128 4276indirect resource use for the families, such as time lostTopiramate vs 0.016 -807 Topiramatefrom work and school assistance;** parents alsolamotrigine dominatesb

completed the parent form of the Child Healtha 2002 valuesQuestionnaire (CHQ-PF50). Annual costs were thenb provides more health gains for a lower costcalculated using local unit costs and prices.

The annual total cost for the whole sample amountedto an average of SEK67 000.† Indirect costs comprised a Adjunctive topiramate best option insignificant > 90% of the total cost burden, at SEK62 500. epilepsyThe level of healthcare resource use varied significantly

A group of researchers from Belgium and the UKby patient diagnosis, with a general trend toward moremodelled the cost effectiveness of different scenarios forresource use for families with children in the ADHD andadjunctive treatment in childhood epilepsy.3††

autism/Aspergers syndrome groups than for those in theTheir Markov model combined data from cost-of-reading/writing disorder group. This resource use

illness studies, clinical trials, utility studies and epilepsy-variation is "explained, to a great extent, by psychosocialrelated mortality surveys, to simulate a cohort ofimpairments", note the researchers. They contend thatpaediatric individuals (aged ≥ 2 years) with epilepsy overthese results indicate that "a treatment, which improvesa 15-year period. At the start of the model, it wasthe psychosocial functioning of the child and family, mayassumed that all patients received the same unspecifiedhave significant potential in reducing family and societalantiepileptic drug therapy, to which the newcosts".antiepileptic is added. Adjunctive treatment with

ADHD takes it toll on children, mothers topiramate 6mg/kg/day was compared with lamotrigineChildren with ADHD have worse health-related 8mg/kg/day, and the expected costs associated with

quality of life (HRQOL) and higher healthcare costs than each treatment were calculated for 2002 from thechildren without ADHD, say investigators from The perspective of the UK National Health Service (NHS).Netherlands.2 In addition, their mothers have higher QOL changes were measured using the EQ-5D, andhealthcare costs and "experience more emotional and future costs and outcomes were discounted at annualtime problems due to caring for child suffering from rates of 6% and 1.5%, respectively.ADHD" than women without such a child, they point The model showed that therapy response ratesout. (defined as ≥ 50% reduction in seizures) were not

The investigators assessed costs and QOL among a significantly different between the topiramate andgroup of children (aged 6–8 years) with a clinical lamotrigine arms. However, in the clinical trials drivingdiagnosis of ADHD under the care of a paediatrician the model, a 5% seizure freedom rate was observed with(n = 70), and a group who were determined to have a topiramate, whereas "no one became seizure free in thelow probability of ADHD (60; controls).‡ A detailed lamotrigine trial", say the researchers. Thus, theyprospective assessment of the burden of ADHD for surmise that patients remained longer on topiramateparents and relatives of the children was carried out; the than lamotrigine therapy, leading to a slightly higherCHQ-PF50 was used to determine HRQOL for mothers gain in quality-adjusted life-years (QALYs) withof the children. Resource use for both children and topiramate [see table]. Topiramate treatment was alsomothers, along with productivity loss for the mothers, less costly, and was "therefore economically dominant"was measured at baseline, and at 6, 12 and 18 months over lamotrigine, in that it resulted in more health gainvia the Trimbos and iMTA questionnaire on Cost for lower costs, the researchers state. They note thatassociated with Psychiatric illness (TiC-P). multivariate sensitivity analysis proved the model to be

The analysis showed that mean scores for physical robust, and confirmed the results of the base-casehealth were not significantly different for children with analysis.and without ADHD. However, mean scores for

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PharmacoEconomics & Outcomes News 15 Jan 2005 No. 4691173-5503/10/0469-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Single Article

generate data on drugs and medical services consumedBurden of rotavirus-associated acutefor paediatric individuals with bronchitis, bronchiolitis,gastroenteritis highpneumonia, croup and apnoea; data regarding parentalRotavirus infections in paediatric individuals are expenses were obtained via telephone interviews.associated with "considerable cost to health care payers", The analysis showed that total costs were an averagesay researchers from Germany.4of €123 per case; 55% of the total cost was attributableThey endeavoured to estimate the overall economic to direct medical costs, 35% to direct nonmedical costs,burden of rotavirus infections causing severe acute and 10% to indirect costs. Costs for children agedgastroenteritis among paediatric individuals aged 0–3 25–26 months were higher than those for youngeryears. The researchers’ study was sponsored by individuals, the researchers note. In addition, there wasGlaxoSmithKline, Germany, and involved analysis of considerable variation in costs across infection types fordata on the incidence of community-acquired and all ages as a whole, with croup resulting in the lowestnosocomial rotavirus infections and healthcare resource average cost per case (€82) and influenza resulting inuse, which were derived from a systematic literature the highest (€223). Based on the estimated number ofreview and official statistics. The analysis showed that total LRTI cases per year among individuals agedthe incidence of community-acquired rotavirus- 0–36 months, the researchers estimated the totalassociated acute gastroenteritis was around 25 per 100 economic burden of LRTIs in Germany at €48.4 millionpaediatric individuals, with a hospitalisation rate of per year.6.15%. Outpatient costs (including those for physicians’* The study received funding from Eli Lilly, Sweden, with which one ofservices, medication and diagnostics) were a mean ofthe researchers was affiliated.€71 per case. Nosocomial rotavirus infections leading** Indirect costs also included those associated with broken things,to acute gastroenteritis occurred at a rate of 1.56 perclothes, parents’ loss of leisure time, sick leave and vacation time from1000 inpatient days, and were responsible for inpatient work.

costs of €326 per patient per day. Moreover, on the† Swedish kronorwhole, work loss for mothers staying at home to care for‡ The study was financially supported by Eli Lilly, The Netherlands,children with rotavirus-associated acute gastroenteritis with which one of the investigators was affiliated.

led to a mean cost per month of €78 for full-time †† The study received funding from Janssen Pharmaceutica, Belgium.workers and €39 for part-time workers. Thus, the One of the researchers was affiliated with Janssen-Cilag, UK, and oneresearchers note that the overall burden of rotavirus- with Johnson & Johnson Pharmaceutical Services, Belgium.associated acute gastroenteritis is substantial, and 1. Myren KJ, et al. Annual societal costs and quality of life in children with"might be even underestimated as not all children are neuropsychiatric disorders in Sweden. Value in Health 7: 780 (plus poster) abstr.

PMH15, No. 6, Nov-Dec 2004.presented to physicians".2. Hakkaart L, et al. The health-related quality of life of children suffering from

ADHD and cost to society. Value in Health 7: 780 (plus poster) abstr. PMH14,Community-acquired LRTI spreads costs inNo. 6, Nov-Dec 2004.

Germany 3. Remak E, et al. Markov model of adjunctive antiepileptic treatment for children- a comparison of topiramate and lamotrigine. Value in Health 7: 792 (plusCommunity-acquired lower respiratory tract infectionposter) abstr. PNL17, No. 6, Nov-Dec 2004.(LRTI) among paediatric individuals poses a 4. Hammerschmidt T, et al. Acute rotavirus gastroenteritis: burden of disease andcost of illness among young children in Germany. Value in Health 7: 762 (plus"considerable economic burden to the health careposter) abstr. PIN15, No. 6, Nov-Dec 2004.system in Germany", say researchers from that country.5

5. Ehlken B, et al. Prospective study on acute lower respiratory tract infection inAs part of the 2-year PRI.DE study, the researchers children younger than 3 years in Germany (PRI.DE) - economic impact of

community-acquired cases treated by office-based pediatricians (primary care).sought to calculate the cost associated with LRTIsValue in Health 7: 765 (plus poster) abstr. PIN23, No. 6, Nov-Dec 2004.among 568 individuals aged 0–36 months; the analysis

800999051was funded by Wyeth, Germany, with which one of theresearchers was affiliated. Chart abstraction was used to

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1173-5503/10/0469-0002/$14.95 Adis © 2010 Springer International Publishing AG. All rights reservedPharmacoEconomics & Outcomes News 15 Jan 2005 No. 469