Economic Evaluation of Extended-Release Amphetamine (Dyanavel XR) Among Individuals with Attention-Deficit/Hyperactivity Disorder From a United States Societal Perspective

Abstract

Introduction: In the treatment of attention-deficit/hyperactivity disorder (ADHD), supplemental use of immediate-release (IR) stimulants can lead to fluctuating plasma levels that impede symptom control and are more prone to diversion. The negative implications of IR stimulant supplementation are broad, leading to extra costs and harm to individuals and society. To quantify the economic impact of IR supplementation from a United States societal perspective, this study evaluated the incremental cost difference between Dyanavel XR and other extended-release (ER) stimulants over a one-year base-case horizon and summarized value using a benefit-cost ratio. Methods: As a hypothesis-generating approach, a decision-tree model compared these interventions across direct medical, non-medical, and indirect costs. Analysis was conducted for the general ADHD population and stratified by age group to account for differences in medication use, adherence, and costs. Suboptimal response combined IR supplementation and patient-reported end-of-dose crash, with all inputs drawn from the published literature. Results: The average per-person cost for Dyanavel XR was $43,219 versus $51,071 for other ER stimulants, resulting in savings of $7,852 per person over one year. Nationally, Dyanavel XR resulted in $44.6 billion in aggregate savings. The benefit-cost ratio of Dyanavel XR was 12.59, indicating that benefits outweighed the treatment cost; 16.89 in young adults and 0.89 in children. In one-way deterministic sensitivity analysis, Dyanavel XR remained cost-saving, highlighting the robustness of the economic benefit. Conclusion: From a United States societal perspective, Dyanavel XR demonstrates an economic advantage over other ER stimulants, with value most pronounced in young adults and lower in children. Dyanavel XR’s potential to reduce IR supplementation and end-of-dose crash, thereby mitigating downstream costs, makes it a compelling ADHD treatment option. The model’s operational definition of suboptimal response is intended as a pragmatic framework for future research to test its predictive validity for clinical outcomes and quality-of-life measures.