Eur J Health Econ
. 2022 Sep 22.
doi: 10.1007/s10198-022-01521-2. Online ahead of print.
Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC 4 E trial in 15 European countries
Xiao Li 1 , Joke Bilcke 2 , Alike W van der Velden 3 , Robin Bruyndonckx 4 5 , Samuel Coenen 5 6 , Emily Bongard 7 , Muirrean de Paor 8 , Slawomir Chlabicz 9 , Maciek Godycki-Cwirko 10 , Nick Francis 11 , Rune Aabenhus 12 , Heiner C Bucher 13 , Annelies Colliers 6 , An De Sutter 14 , Ana Garcia-Sangenis 15 , Dominik Glinz 16 , Nicolay J Harbin 17 , Katarzyna Kosiek 18 , Morten Lindbæk 19 , Christos Lionis 20 , Carl Llor 15 21 , Réka Mikó-Pauer 22 , Ruta Radzeviciene Jurgute 23 , Bohumil Seifert 24 , Pär-Daniel Sundvall 25 26 , Pia Touboul Lundgren 27 , Nikolaos Tsakountakis 28 , Theo J Verheij 3 , Herman Goossens 6 , Christopher C Butler 7 , Philippe Beutels 2 , ALIC4Etrial investigators
Collaborators, Affiliations
- PMID: 36131214
- DOI: 10.1007/s10198-022-01521-2
Abstract
Background: Oseltamivir is usually not often prescribed (or reimbursed) for non-high-risk patients consulting for influenza-like-illness (ILI) in primary care in Europe. We aimed to evaluate the cost-effectiveness of adding oseltamivir to usual primary care in adults/adolescents (13 years +) and children with ILI during seasonal influenza epidemics, using data collected in an open-label, multi-season, randomised controlled trial of oseltamivir in 15 European countries.
Methods: Direct and indirect cost estimates were based on patient reported resource use and official country-specific unit costs. Health-Related Quality of Life was assessed by EQ-5D questionnaires. Costs and quality adjusted life-years (QALY) were bootstrapped (N = 10,000) to estimate incremental cost-effectiveness ratios (ICER), from both the healthcare payers' and the societal perspectives, with uncertainty expressed through probabilistic sensitivity analysis and expected value for perfect information (EVPI) analysis. Additionally, scenario (self-reported spending), comorbidities subgroup and country-specific analyses were performed.
Results: The healthcare payers' expected ICERs of oseltamivir were €22,459 per QALY gained in adults/adolescents and €13,001 in children. From the societal perspective, oseltamivir was cost-saving in adults/adolescents, but the ICER is €8,344 in children. Large uncertainties were observed in subgroups with comorbidities, especially for children. The expected ICERs and extent of decision uncertainty varied between countries (EVPI ranged €1-€35 per patient).
Conclusion: Adding oseltamivir to primary usual care in Europe is likely to be cost-effective for treating adults/adolescents and children with ILI from the healthcare payers' perspective (if willingness-to-pay per QALY gained > €22,459) and cost-saving in adults/adolescents from a societal perspective.
Keywords: Cost-utility analysis; Direct cost; Europe; ILI; Indirect cost; Multi-country; Productivity losses; QALY; Tamiflu.