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Am J Prev Med. Oseltamivir for Influenza Postexposure Prophylaxis: Economic Evaluation for Children Aged 1?12 Years in the U.S.
Oseltamivir for Influenza Postexposure Prophylaxis: Economic Evaluation for Children Aged 1?12 Years in the U.S. (abstract, edited)
Oseltamivir for Influenza Postexposure Prophylaxis: Economic Evaluation for Children Aged 1?12 Years in the U.S.
Sandra E. Talbird, MSPHa, Anita J. Brogan, PhDa, Aleksander P. Winiarski, PharmDb
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.
a Research Triangle Institute (RTI), Health Solutions, Research Triangle Park, North Carolina
b Roche Laboratories, Inc., Nutley, New Jersey
Corresponding Author Information
Address correspondence and reprint requests to: Sandra E. Talbird, MSPH, RTI Health Solutions, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park NC 27709
The full text of this article is available via AJPM Online at www.ajpm-online.net
PII: S0749-3797(09)00527-3
doi:10.1016/j.amepre.2009.08.012
? 2009 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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<cite cite="http://www.ajpm-online.net/article/PIIS0749379709005273/abstract?rss=yes">Oseltamivir for Influenza Postexposure Prophylaxis: Economic Evaluation for Children Aged 1?12 Years in the U.S.</cite>
Sandra E. Talbird, MSPHa, Anita J. Brogan, PhDa, Aleksander P. Winiarski, PharmDb
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.
a Research Triangle Institute (RTI), Health Solutions, Research Triangle Park, North Carolina
b Roche Laboratories, Inc., Nutley, New Jersey
Corresponding Author Information
Address correspondence and reprint requests to: Sandra E. Talbird, MSPH, RTI Health Solutions, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park NC 27709
The full text of this article is available via AJPM Online at www.ajpm-online.net
PII: S0749-3797(09)00527-3
doi:10.1016/j.amepre.2009.08.012
? 2009 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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