tetano
Editor, Senior Moderator
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 [SUP]4[/SUP] E trial in 15 European countries
Xiao Li[SUP] 1 [/SUP], Joke Bilcke[SUP] 2 [/SUP], Alike W van der Velden[SUP] 3 [/SUP], Robin Bruyndonckx[SUP] 4 5 [/SUP], Samuel Coenen[SUP] 5 6 [/SUP], Emily Bongard[SUP] 7 [/SUP], Muirrean de Paor[SUP] 8 [/SUP], Slawomir Chlabicz[SUP] 9 [/SUP], Maciek Godycki-Cwirko[SUP] 10 [/SUP], Nick Francis[SUP] 11 [/SUP], Rune Aabenhus[SUP] 12 [/SUP], Heiner C Bucher[SUP] 13 [/SUP], Annelies Colliers[SUP] 6 [/SUP], An De Sutter[SUP] 14 [/SUP], Ana Garcia-Sangenis[SUP] 15 [/SUP], Dominik Glinz[SUP] 16 [/SUP], Nicolay J Harbin[SUP] 17 [/SUP], Katarzyna Kosiek[SUP] 18 [/SUP], Morten Lindbæk[SUP] 19 [/SUP], Christos Lionis[SUP] 20 [/SUP], Carl Llor[SUP] 15 21 [/SUP], Réka Mikó-Pauer[SUP] 22 [/SUP], Ruta Radzeviciene Jurgute[SUP] 23 [/SUP], Bohumil Seifert[SUP] 24 [/SUP], Pär-Daniel Sundvall[SUP] 25 26 [/SUP], Pia Touboul Lundgren[SUP] 27 [/SUP], Nikolaos Tsakountakis[SUP] 28 [/SUP], Theo J Verheij[SUP] 3 [/SUP], Herman Goossens[SUP] 6 [/SUP], Christopher C Butler[SUP] 7 [/SUP], Philippe Beutels[SUP] 2 [/SUP], ALIC4Etrial investigators
Collaborators, Affiliations
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.
. 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 [SUP]4[/SUP] E trial in 15 European countries
Xiao Li[SUP] 1 [/SUP], Joke Bilcke[SUP] 2 [/SUP], Alike W van der Velden[SUP] 3 [/SUP], Robin Bruyndonckx[SUP] 4 5 [/SUP], Samuel Coenen[SUP] 5 6 [/SUP], Emily Bongard[SUP] 7 [/SUP], Muirrean de Paor[SUP] 8 [/SUP], Slawomir Chlabicz[SUP] 9 [/SUP], Maciek Godycki-Cwirko[SUP] 10 [/SUP], Nick Francis[SUP] 11 [/SUP], Rune Aabenhus[SUP] 12 [/SUP], Heiner C Bucher[SUP] 13 [/SUP], Annelies Colliers[SUP] 6 [/SUP], An De Sutter[SUP] 14 [/SUP], Ana Garcia-Sangenis[SUP] 15 [/SUP], Dominik Glinz[SUP] 16 [/SUP], Nicolay J Harbin[SUP] 17 [/SUP], Katarzyna Kosiek[SUP] 18 [/SUP], Morten Lindbæk[SUP] 19 [/SUP], Christos Lionis[SUP] 20 [/SUP], Carl Llor[SUP] 15 21 [/SUP], Réka Mikó-Pauer[SUP] 22 [/SUP], Ruta Radzeviciene Jurgute[SUP] 23 [/SUP], Bohumil Seifert[SUP] 24 [/SUP], Pär-Daniel Sundvall[SUP] 25 26 [/SUP], Pia Touboul Lundgren[SUP] 27 [/SUP], Nikolaos Tsakountakis[SUP] 28 [/SUP], Theo J Verheij[SUP] 3 [/SUP], Herman Goossens[SUP] 6 [/SUP], Christopher C Butler[SUP] 7 [/SUP], Philippe Beutels[SUP] 2 [/SUP], 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.