Tags

Type your tag names separated by a space and hit enter

Cost-effectiveness of newer treatment strategies for influenza.
Am J Med 2002; 113(4):300-7AJ

Abstract

PURPOSE

Recent advances in the diagnosis and treatment of influenza, such as rapid testing and neuraminidase inhibitor therapy, are available, but their place in clinical practice and their cost-effectiveness have not been determined.

MATERIALS AND METHODS

To estimate the cost-effectiveness of these newer interventions, we used a decision model that compared several influenza management strategies: no testing or treatment, amantadine or rimantadine treatment without testing, testing then amantadine or rimantadine treatment, neuraminidase inhibitor treatment without testing, or testing then neuraminidase inhibitor treatment. Antiviral therapy began within 48 hours in febrile patients with characteristic symptoms of influenza. We assumed that antiviral treatment did not change rates of influenza complication or mortality, and chose parameter values in the baseline analysis to bias slightly against antiviral treatment and toward testing strategies.

RESULTS

In the baseline analysis, testing strategies are more expensive and less effective than treatment strategies. Amantadine costs $9.06 per illness day avoided or $11.60 per quality-adjusted day gained. Compared with amantadine, zanamivir costs $198 per illness day avoided or $185 per quality-adjusted day gained, whereas oseltamivir costs $252 per illness day avoided or $235 per quality-adjusted day gained. In elderly patients who require reduced dosage, rimantadine costs $128 per quality-adjusted day gained compared with amantadine. In younger patients, amantadine is favored if the likelihood of influenza A is >67%; otherwise, neuraminidase inhibitors are favored. Testing strategies are more costly and less effective when the influenza probability is >30%. No testing or treatment is favored if the influenza probability is <32% and the influenza utility is >0.77. In elderly patients, amantadine is favored over rimantadine if the utility of medication side effects is >0.94.

CONCLUSIONS

Antiviral treatment of influenza without rapid testing is reasonable economically in febrile patients with typical symptoms during influenza season. The choice of antiviral agent depends on age, the likelihood of influenza A, and the willingness to pay per quality-adjusted day gained.

Authors+Show Affiliations

Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, and the Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. smithkj2@msx.upmc.eduNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12361816

Citation

Smith, Kenneth J., and Mark S. Roberts. "Cost-effectiveness of Newer Treatment Strategies for Influenza." The American Journal of Medicine, vol. 113, no. 4, 2002, pp. 300-7.
Smith KJ, Roberts MS. Cost-effectiveness of newer treatment strategies for influenza. Am J Med. 2002;113(4):300-7.
Smith, K. J., & Roberts, M. S. (2002). Cost-effectiveness of newer treatment strategies for influenza. The American Journal of Medicine, 113(4), pp. 300-7.
Smith KJ, Roberts MS. Cost-effectiveness of Newer Treatment Strategies for Influenza. Am J Med. 2002;113(4):300-7. PubMed PMID: 12361816.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of newer treatment strategies for influenza. AU - Smith,Kenneth J, AU - Roberts,Mark S, PY - 2002/10/4/pubmed PY - 2002/10/31/medline PY - 2002/10/4/entrez SP - 300 EP - 7 JF - The American journal of medicine JO - Am. J. Med. VL - 113 IS - 4 N2 - PURPOSE: Recent advances in the diagnosis and treatment of influenza, such as rapid testing and neuraminidase inhibitor therapy, are available, but their place in clinical practice and their cost-effectiveness have not been determined. MATERIALS AND METHODS: To estimate the cost-effectiveness of these newer interventions, we used a decision model that compared several influenza management strategies: no testing or treatment, amantadine or rimantadine treatment without testing, testing then amantadine or rimantadine treatment, neuraminidase inhibitor treatment without testing, or testing then neuraminidase inhibitor treatment. Antiviral therapy began within 48 hours in febrile patients with characteristic symptoms of influenza. We assumed that antiviral treatment did not change rates of influenza complication or mortality, and chose parameter values in the baseline analysis to bias slightly against antiviral treatment and toward testing strategies. RESULTS: In the baseline analysis, testing strategies are more expensive and less effective than treatment strategies. Amantadine costs $9.06 per illness day avoided or $11.60 per quality-adjusted day gained. Compared with amantadine, zanamivir costs $198 per illness day avoided or $185 per quality-adjusted day gained, whereas oseltamivir costs $252 per illness day avoided or $235 per quality-adjusted day gained. In elderly patients who require reduced dosage, rimantadine costs $128 per quality-adjusted day gained compared with amantadine. In younger patients, amantadine is favored if the likelihood of influenza A is >67%; otherwise, neuraminidase inhibitors are favored. Testing strategies are more costly and less effective when the influenza probability is >30%. No testing or treatment is favored if the influenza probability is <32% and the influenza utility is >0.77. In elderly patients, amantadine is favored over rimantadine if the utility of medication side effects is >0.94. CONCLUSIONS: Antiviral treatment of influenza without rapid testing is reasonable economically in febrile patients with typical symptoms during influenza season. The choice of antiviral agent depends on age, the likelihood of influenza A, and the willingness to pay per quality-adjusted day gained. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/12361816/Cost_effectiveness_of_newer_treatment_strategies_for_influenza_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002934302012226 DB - PRIME DP - Unbound Medicine ER -