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Management of influenza symptoms in healthy children: cost-effectiveness of rapid testing and antiviral therapy.

Abstract

OBJECTIVE

To determine the cost-effectiveness of rapid testing and antiviral therapy for children of different ages with symptoms of influenza.

DESIGN

Cost-effectiveness analysis from the societal perspective using a decision model based on published data.

SETTING

Physician's office during an influenza A epidemic.

PARTICIPANTS

Hypothetical children aged 2, 7, and 15 years.

INTERVENTIONS

Rapid testing or clinical diagnosis followed by treatment with amantadine hydrochloride or oseltamivir phosphate compared with no antiviral therapy.

OUTCOME MEASURES

Costs and quality-adjusted life expectancy.

RESULTS

Empirical therapy with antiviral medication resulted in the greatest quality-adjusted life expectancy in all age groups. Compared with not treating, antiviral therapy improved quality-adjusted life expectancy by 0.003 quality-adjusted life-year by shortening the duration of illness and preventing otitis media. In young children it saved up to USD 121 per child mostly by avoiding parental work loss. Excluding work loss, antiviral therapy improved quality-adjusted life expectancy at a cost of USD 800 to 1800 per quality-adjusted life-year saved. Compared with amantadine, oseltamivir was not cost-effective when influenza A predominated. The incremental cost-effectiveness of oseltamivir fell below USD 50 000 per quality-adjusted life-year saved when the proportion of influenza B exceeded 14% for a 2-year-old, 27% for a 7-year-old, or 43% for a 15-year-old. Rapid testing was cost-effective only when the probability of influenza was 60% or less.

CONCLUSIONS

For children presenting with influenza symptoms during a local influenza outbreak, treatment with antiviral therapy appears to offer the best outcome and often saves money. The choice of antiviral drug should be based on the prevalence of influenza B.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA. Michael.Rothberg@bhs.org

    , ,

    Source

    MeSH

    Adolescent
    Antiviral Agents
    Child
    Child, Preschool
    Clinical Trials as Topic
    Computer Simulation
    Cost-Benefit Analysis
    Diagnostic Tests, Routine
    Humans
    Influenza, Human
    Quality-Adjusted Life Years

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    16275797

    Citation

    TY - JOUR T1 - Management of influenza symptoms in healthy children: cost-effectiveness of rapid testing and antiviral therapy. AU - Rothberg,Michael B, AU - Fisher,Donna, AU - Kelly,Brendan, AU - Rose,David N, PY - 2005/11/9/pubmed PY - 2005/12/13/medline PY - 2005/11/9/entrez SP - 1055 EP - 62 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 159 IS - 11 N2 - OBJECTIVE: To determine the cost-effectiveness of rapid testing and antiviral therapy for children of different ages with symptoms of influenza. DESIGN: Cost-effectiveness analysis from the societal perspective using a decision model based on published data. SETTING: Physician's office during an influenza A epidemic. PARTICIPANTS: Hypothetical children aged 2, 7, and 15 years. INTERVENTIONS: Rapid testing or clinical diagnosis followed by treatment with amantadine hydrochloride or oseltamivir phosphate compared with no antiviral therapy. OUTCOME MEASURES: Costs and quality-adjusted life expectancy. RESULTS: Empirical therapy with antiviral medication resulted in the greatest quality-adjusted life expectancy in all age groups. Compared with not treating, antiviral therapy improved quality-adjusted life expectancy by 0.003 quality-adjusted life-year by shortening the duration of illness and preventing otitis media. In young children it saved up to USD 121 per child mostly by avoiding parental work loss. Excluding work loss, antiviral therapy improved quality-adjusted life expectancy at a cost of USD 800 to 1800 per quality-adjusted life-year saved. Compared with amantadine, oseltamivir was not cost-effective when influenza A predominated. The incremental cost-effectiveness of oseltamivir fell below USD 50 000 per quality-adjusted life-year saved when the proportion of influenza B exceeded 14% for a 2-year-old, 27% for a 7-year-old, or 43% for a 15-year-old. Rapid testing was cost-effective only when the probability of influenza was 60% or less. CONCLUSIONS: For children presenting with influenza symptoms during a local influenza outbreak, treatment with antiviral therapy appears to offer the best outcome and often saves money. The choice of antiviral drug should be based on the prevalence of influenza B. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/16275797/full_citation L2 - http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/archpedi.159.11.1055 ER -