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

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.