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Oseltamivir for influenza postexposure prophylaxis: economic evaluation for children aged 1-12 years in the U.S.
Am J Prev Med 2009; 37(5):381-8AJ

Abstract

BACKGROUND

Postexposure prophylaxis (PEP) with oseltamivir (Tamiflu) has been shown to be effective and is approved in children exposed to a case of influenza in a household setting. Given limited healthcare budgets, it is important to understand the costs and cost effectiveness of PEP in children.

PURPOSE

This study aims to estimate the cost effectiveness of oseltamivir PEP for children aged 1-12 years in the U.S.

METHODS

A decision-tree model with a 1-year time horizon was used to assess the cost effectiveness of oseltamivir PEP for 10 days at approved doses compared with no prophylaxis for children aged 1-12 years who were exposed to a household index case of influenza from the U.S. societal and payer perspectives. Model inputs included U.S. influenza epidemiology data, efficacy data from oseltamivir PEP clinical trials, direct medical resource use and costs for PEP and influenza treatment derived from large U.S. databases, and indirect costs based on caregiver lost productivity. Base-case estimates were tested in extensive sensitivity analyses.

RESULTS

For the societal perspective, the model estimated 12,184 fewer cases of influenza per 100,000 children exposed and an incremental cost-effectiveness ratio of $41,452 per quality-adjusted life-year (QALY) gained. Results were most sensitive to the influenza attack rate, PEP protective efficacy, and prescribing patterns for initiating PEP. Probabilistic sensitivity analyses showed that oseltamivir PEP was likely to be cost effective for all willingness-to-pay threshold values above $34,300 per QALY gained. Results were similar for the payer perspective.

CONCLUSIONS

Although there is no official cost-effectiveness threshold in the U.S., results from the current study show that when compared with no prophylaxis, oseltamivir PEP for children has cost-effectiveness ratios similar to those of vaccines for preventing influenza.

Authors+Show Affiliations

Research Triangle Institute (RTI), Health Solutions, Research Triangle Park, NC 27709, USA. stalbird@rti.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19840692

Citation

Talbird, Sandra E., et al. "Oseltamivir for Influenza Postexposure Prophylaxis: Economic Evaluation for Children Aged 1-12 Years in the U.S." American Journal of Preventive Medicine, vol. 37, no. 5, 2009, pp. 381-8.
Talbird SE, Brogan AJ, Winiarski AP. Oseltamivir for influenza postexposure prophylaxis: economic evaluation for children aged 1-12 years in the U.S. Am J Prev Med. 2009;37(5):381-8.
Talbird, S. E., Brogan, A. J., & Winiarski, A. P. (2009). Oseltamivir for influenza postexposure prophylaxis: economic evaluation for children aged 1-12 years in the U.S. American Journal of Preventive Medicine, 37(5), pp. 381-8. doi:10.1016/j.amepre.2009.08.012.
Talbird SE, Brogan AJ, Winiarski AP. Oseltamivir for Influenza Postexposure Prophylaxis: Economic Evaluation for Children Aged 1-12 Years in the U.S. Am J Prev Med. 2009;37(5):381-8. PubMed PMID: 19840692.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oseltamivir for influenza postexposure prophylaxis: economic evaluation for children aged 1-12 years in the U.S. AU - Talbird,Sandra E, AU - Brogan,Anita J, AU - Winiarski,Aleksander P, PY - 2008/12/09/received PY - 2009/06/09/revised PY - 2009/08/10/accepted PY - 2009/10/21/entrez PY - 2009/10/21/pubmed PY - 2010/1/19/medline SP - 381 EP - 8 JF - American journal of preventive medicine JO - Am J Prev Med VL - 37 IS - 5 N2 - BACKGROUND: Postexposure prophylaxis (PEP) with oseltamivir (Tamiflu) has been shown to be effective and is approved in children exposed to a case of influenza in a household setting. Given limited healthcare budgets, it is important to understand the costs and cost effectiveness of PEP in children. PURPOSE: This study aims to estimate the cost effectiveness of oseltamivir PEP for children aged 1-12 years in the U.S. METHODS: A decision-tree model with a 1-year time horizon was used to assess the cost effectiveness of oseltamivir PEP for 10 days at approved doses compared with no prophylaxis for children aged 1-12 years who were exposed to a household index case of influenza from the U.S. societal and payer perspectives. Model inputs included U.S. influenza epidemiology data, efficacy data from oseltamivir PEP clinical trials, direct medical resource use and costs for PEP and influenza treatment derived from large U.S. databases, and indirect costs based on caregiver lost productivity. Base-case estimates were tested in extensive sensitivity analyses. RESULTS: For the societal perspective, the model estimated 12,184 fewer cases of influenza per 100,000 children exposed and an incremental cost-effectiveness ratio of $41,452 per quality-adjusted life-year (QALY) gained. Results were most sensitive to the influenza attack rate, PEP protective efficacy, and prescribing patterns for initiating PEP. Probabilistic sensitivity analyses showed that oseltamivir PEP was likely to be cost effective for all willingness-to-pay threshold values above $34,300 per QALY gained. Results were similar for the payer perspective. CONCLUSIONS: Although there is no official cost-effectiveness threshold in the U.S., results from the current study show that when compared with no prophylaxis, oseltamivir PEP for children has cost-effectiveness ratios similar to those of vaccines for preventing influenza. SN - 1873-2607 UR - https://www.unboundmedicine.com/medline/citation/19840692/Oseltamivir_for_influenza_postexposure_prophylaxis:_economic_evaluation_for_children_aged_1_12_years_in_the_U_S_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(09)00527-3 DB - PRIME DP - Unbound Medicine ER -