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Management of influenza symptoms in healthy adults.
J Gen Intern Med 2003; 18(10):808-15JG

Abstract

OBJECTIVE

To determine the cost-effectiveness of rapid diagnostic testing and empiric antiviral therapy for healthy adults with symptoms of influenza.

DESIGN

Cost-effectiveness analysis using a decision model based on previously published data. Outcome measures included costs and quality-adjusted life expectancy.

SETTING

Physician's office.

PATIENTS/PARTICIPANTS

Hypothetically healthy, working adults < 65 years of age presenting with cough and fever during the influenza season.

INTERVENTIONS

Rapid testing or clinical diagnosis followed by treatment with amantadine, rimantadine, oseltamivir, or zanamivir compared with no antiviral therapy.

RESULTS

Base-case analysis: not giving antiviral therapy is the most expensive and least effective strategy, costing 471 dollars per patient, mostly owing to time lost from work. Amantadine treatment increases life expectancy by 0.0014 quality-adjusted life years (QALYs) while saving 108 dollars per patient relative to no antiviral therapy. Zanamivir is slightly more effective than amantadine, adding 0.0002 QALYs at an incremental cost of 31 dollars, or 133,000 dollars per QALY saved. All other strategies, including testing strategies, are both less effective and more expensive. SENSITIVITY ANALYSIS: The model is sensitive to the probability of influenza infection, proportion of influenza caused by type B, the relative efficacy of the various drugs, and the value of a workday. At a clinical probability of influenza infection > 20%, antiviral therapy is favored. As the proportion of influenza B increases, zanamivir is favored over amantadine. Testing is rarely indicated. Ignoring the costs of lost workdays, amantadine treatment costs 1,200 dollars/QALY saved.

CONCLUSIONS

Antiviral therapy with either amantadine or zanamivir is cost-effective for healthy, young patients with influenza-like illness during the influenza season, depending on the prevalence of influenza B.

Authors+Show Affiliations

Division of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, Springfield, MA 01199, USA. Michael.Rothberg@bhs.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

14521643

Citation

Rothberg, Michael B., et al. "Management of Influenza Symptoms in Healthy Adults." Journal of General Internal Medicine, vol. 18, no. 10, 2003, pp. 808-15.
Rothberg MB, He S, Rose DN. Management of influenza symptoms in healthy adults. J Gen Intern Med. 2003;18(10):808-15.
Rothberg, M. B., He, S., & Rose, D. N. (2003). Management of influenza symptoms in healthy adults. Journal of General Internal Medicine, 18(10), pp. 808-15.
Rothberg MB, He S, Rose DN. Management of Influenza Symptoms in Healthy Adults. J Gen Intern Med. 2003;18(10):808-15. PubMed PMID: 14521643.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of influenza symptoms in healthy adults. AU - Rothberg,Michael B, AU - He,Shunian, AU - Rose,David N, PY - 2003/10/3/pubmed PY - 2004/3/20/medline PY - 2003/10/3/entrez SP - 808 EP - 15 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 18 IS - 10 N2 - OBJECTIVE: To determine the cost-effectiveness of rapid diagnostic testing and empiric antiviral therapy for healthy adults with symptoms of influenza. DESIGN: Cost-effectiveness analysis using a decision model based on previously published data. Outcome measures included costs and quality-adjusted life expectancy. SETTING: Physician's office. PATIENTS/PARTICIPANTS: Hypothetically healthy, working adults < 65 years of age presenting with cough and fever during the influenza season. INTERVENTIONS: Rapid testing or clinical diagnosis followed by treatment with amantadine, rimantadine, oseltamivir, or zanamivir compared with no antiviral therapy. RESULTS: Base-case analysis: not giving antiviral therapy is the most expensive and least effective strategy, costing 471 dollars per patient, mostly owing to time lost from work. Amantadine treatment increases life expectancy by 0.0014 quality-adjusted life years (QALYs) while saving 108 dollars per patient relative to no antiviral therapy. Zanamivir is slightly more effective than amantadine, adding 0.0002 QALYs at an incremental cost of 31 dollars, or 133,000 dollars per QALY saved. All other strategies, including testing strategies, are both less effective and more expensive. SENSITIVITY ANALYSIS: The model is sensitive to the probability of influenza infection, proportion of influenza caused by type B, the relative efficacy of the various drugs, and the value of a workday. At a clinical probability of influenza infection > 20%, antiviral therapy is favored. As the proportion of influenza B increases, zanamivir is favored over amantadine. Testing is rarely indicated. Ignoring the costs of lost workdays, amantadine treatment costs 1,200 dollars/QALY saved. CONCLUSIONS: Antiviral therapy with either amantadine or zanamivir is cost-effective for healthy, young patients with influenza-like illness during the influenza season, depending on the prevalence of influenza B. SN - 0884-8734 UR - https://www.unboundmedicine.com/medline/citation/14521643/Management_of_influenza_symptoms_in_healthy_adults_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0884-8734&amp;date=2003&amp;volume=18&amp;issue=10&amp;spage=808 DB - PRIME DP - Unbound Medicine ER -