Cost-Effectiveness of a Child and Parent Mindfulness-Based Training Versus Medication for Childhood ADHD.

Abstract

Objective: ADHD imposes substantial societal costs. This randomized controlled trial examined the cost-effectiveness of family mindfulness training ("MYmind") versus medication in childhood ADHD.

Method: An economic evaluation with a 10-month time horizon was conducted from a societal perspective. Children (N = 88, M = 11.27 years, 70% boys) with ADHD were randomized to MYmind (8 weekly 1.5-hr group mindfulness sessions for children and parallel for their parents, plus a 2-months follow-up) or medication (4-months immediate-release methylphenidate). During the following 6 months, families had free treatment choice, allowing crossover. Costs were assessed using retrospective cost-questionnaires. Primary outcome measures were children's inattention and quality-adjusted life years (QALYs). Secondary analyses included: hyperactivity/impulsivity, internalizing and externalizing problems as outcome measures, taking a healthcare (payers) perspective, shorter time horizons (2 and 4 months), a different inattention questionnaire, per protocol analyses, and exclusion of crossover participants.

Results: At 10 months, primary cost-effectiveness analyses indicated that MYmind was inferior to medication for inattention but had higher QALY gains at higher costs. Specifically, MYmind had a 27% probability of being cost-effective for inattention and a 30% probability for QALYs. Secondary analyses showed similar results with even lower chances for mindfulness being cost-effective in the shorter-term horizons. Notably, in the subgroup excluding crossover participants, MYmind was dominant over medication, with an 81% chance to be cost-effective for both outcomes.

Conclusions: MYmind was less cost-effective than medication in the short and medium term. Long-term cost-effectiveness of MYmind remained low for the total group, but was high among participants who did not crossover to the alternative treatment.