The analysis was based on a Markov simulation, with a 10-year horizon and a hypothetical cohort of seven-year-old children with ADHD. The authors stated that the analysis was carried out from a societal perspective.
Most of the evidence was from cohort and observational studies. Some assumptions were made where there was no relevant published evidence. For example, the risk of sudden cardiac death, with stimulant medications, was based on authors’ assumptions. The accuracy of the screening strategies was the key input for the analysis.
Monetary benefit and utility valuations:
The utility values were from a study that assessed them using the standard gamble method, in the parents of children with ADHD.
Measure of benefit:
Quality-adjusted life-years (QALYs) were the summary benefit measure and were discounted at an annual rate of 3%. The number of sudden cardiac deaths was presented for each strategy.
Three main cost categories were considered; medications, medication-related visits, and patient or parent time for treatment. A breakdown of cost items was reported. The costs for physician services, ECG, and echocardiogram were from the 2009 Medicare Physician Fee Schedule and those for medication were from the 2008 Red Book. All costs were in US dollars ($) and a 3% annual discount rate was applied.
Analysis of uncertainty:
A Monte Carlo simulation was undertaken, using beta distributions, to examine if the base-case findings were robust. One-way sensitivity analyses were performed on all the individual variables, using published or arbitrary ranges of values. A two-way analysis was carried out varying the sudden cardiac death risk from playing competitive sports and the percentage of students playing them.