Pharmacoeconomic and Treatment Adherence Considerations

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Proper ADHD treatment is a substantial financial burden. Annual health care costs of patients with ADHD are more than double those of patients without ADHD

($1,343 versus $503, respectively). The financial burden of ADHD can be attributed to the direct cost of pharmacotherapy, office visits, diagnostic measurements, therapy monitoring, and indirect costs (e.g., lost work time and productivity). When selecting a treatment for an ADHD patient, the cost burden to the patient's family should be considered. Immediate-release stimulants may be more cost-effective in many patients compared with longer-acting stimulant formulations (Table 42-4), but in certain circumstances, longer-acting stimulant formulations may provide a greater benefit owing to increased adherence to the medication and prolonged control of symptoms of ADHD. Some nonstimulant ADHD medications (e.g., bupropion, TCAs, and a2-ad-renergic agonists) appear to be less costly than many stimulant formulations; however, these agents have not been proven to have superior efficacy over stimulants in treating ADHD. Decisions on selection of specific ADHD medications should not be based solely on cost, but on efficacy and safety, along with adherence to the prescribed regimen, should be considered foremost.

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