tetano
Editor, Senior Moderator
Br J Clin Pharmacol. 2017 Feb 8. doi: 10.1111/bcp.13229. [Epub ahead of print]
[h=1]Interdisciplinary Pharmacometrics Linking Oseltamivir Pharmacology, Influenza Epidemiology, and Health Economics to Inform Antiviral Use in Pandemics.[/h] Kamal MA[SUP]1,[/SUP][SUP]2[/SUP], Smith PF[SUP]3,[/SUP][SUP]4[/SUP], Chaiyakunapruk N[SUP]5[/SUP], Wu DB[SUP]5[/SUP], Pratoomsoot C[SUP]5,[/SUP][SUP]6[/SUP], Lee KK[SUP]5[/SUP], Chong HY[SUP]5[/SUP], Nelson RE[SUP]7[/SUP], Nieforth K[SUP]4[/SUP], Dall G[SUP]4[/SUP], Toovey S[SUP]8[/SUP], Kong DC[SUP]5[/SUP], Kamauu A[SUP]9[/SUP], Kirkpatrick CM[SUP]5[/SUP], Rayner CR[SUP]4,[/SUP][SUP]5[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]AIM:[/h] A modular interdisciplinary platform was developed to investigate the economic impact of oseltamivir treatment by dosage regimen under simulated influenza pandemic scenarios.
[h=4]METHODS:[/h] The pharmacology module consisted of a pharmacokinetic distribution of oseltamivir carboxylate AUC[SUB]0-24h[/SUB] at steady state (simulated for 75 mg and 150 mg BID regimens for 5 days) and a pharmacodynamic distribution of viral shedding duration (T[SUB]shed[/SUB] ) obtained from phase II influenza inoculation data. The epidemiological module comprised a SEIR (susceptible, exposed, infected, recovered) model to which drug effect on the basic reproductive number (R[SUB]0[/SUB] ), a measure of transmissibility, was linked by reduction of T[SUB]shed[/SUB] . The number of infected patients per population of 100,000 susceptible individuals was simulated for a series of pandemic scenarios, varying oseltamivir dose, R[SUB]0[/SUB] (1.9 vs. 2.7), and drug uptake (25%, 50%, and 80%). The number of infected patients for each scenario was entered into the health economics module, a decision analytic model populated with branch probabilities, disease utility, costs of hospitalized patients developing complications, and case-fatality rates. Change in Quality adjusted life years (ΔQALY) was determined relative to base case.
[h=4]RESULTS:[/h] Oseltamivir 75 mg relative to no treatment reduced the median number of infected patients, increased ΔQALY by deaths averted, and was cost-saving under all scenarios; 150 mg relative to 75 mg was not cost effective in low transmissibility scenarios but was cost saving in high transmissibility scenarios.
[h=4]CONCLUSION:[/h] This methodological study demonstrates proof of concept that the disciplines of pharmacology, disease epidemiology, and health economics can be linked in a single quantitative framework.
This article is protected by copyright. All rights reserved.
[h=4]KEYWORDS:[/h] Epidemiology; Health Economics; Influenza; Influenza Pandemics; Interdisciplinary Pharmacometrics; Oseltamivir; PK/PD
PMID: 28176362 DOI: 10.1111/bcp.13229
[PubMed - as supplied by publisher]
[h=1]Interdisciplinary Pharmacometrics Linking Oseltamivir Pharmacology, Influenza Epidemiology, and Health Economics to Inform Antiviral Use in Pandemics.[/h] Kamal MA[SUP]1,[/SUP][SUP]2[/SUP], Smith PF[SUP]3,[/SUP][SUP]4[/SUP], Chaiyakunapruk N[SUP]5[/SUP], Wu DB[SUP]5[/SUP], Pratoomsoot C[SUP]5,[/SUP][SUP]6[/SUP], Lee KK[SUP]5[/SUP], Chong HY[SUP]5[/SUP], Nelson RE[SUP]7[/SUP], Nieforth K[SUP]4[/SUP], Dall G[SUP]4[/SUP], Toovey S[SUP]8[/SUP], Kong DC[SUP]5[/SUP], Kamauu A[SUP]9[/SUP], Kirkpatrick CM[SUP]5[/SUP], Rayner CR[SUP]4,[/SUP][SUP]5[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]AIM:[/h] A modular interdisciplinary platform was developed to investigate the economic impact of oseltamivir treatment by dosage regimen under simulated influenza pandemic scenarios.
[h=4]METHODS:[/h] The pharmacology module consisted of a pharmacokinetic distribution of oseltamivir carboxylate AUC[SUB]0-24h[/SUB] at steady state (simulated for 75 mg and 150 mg BID regimens for 5 days) and a pharmacodynamic distribution of viral shedding duration (T[SUB]shed[/SUB] ) obtained from phase II influenza inoculation data. The epidemiological module comprised a SEIR (susceptible, exposed, infected, recovered) model to which drug effect on the basic reproductive number (R[SUB]0[/SUB] ), a measure of transmissibility, was linked by reduction of T[SUB]shed[/SUB] . The number of infected patients per population of 100,000 susceptible individuals was simulated for a series of pandemic scenarios, varying oseltamivir dose, R[SUB]0[/SUB] (1.9 vs. 2.7), and drug uptake (25%, 50%, and 80%). The number of infected patients for each scenario was entered into the health economics module, a decision analytic model populated with branch probabilities, disease utility, costs of hospitalized patients developing complications, and case-fatality rates. Change in Quality adjusted life years (ΔQALY) was determined relative to base case.
[h=4]RESULTS:[/h] Oseltamivir 75 mg relative to no treatment reduced the median number of infected patients, increased ΔQALY by deaths averted, and was cost-saving under all scenarios; 150 mg relative to 75 mg was not cost effective in low transmissibility scenarios but was cost saving in high transmissibility scenarios.
[h=4]CONCLUSION:[/h] This methodological study demonstrates proof of concept that the disciplines of pharmacology, disease epidemiology, and health economics can be linked in a single quantitative framework.
This article is protected by copyright. All rights reserved.
[h=4]KEYWORDS:[/h] Epidemiology; Health Economics; Influenza; Influenza Pandemics; Interdisciplinary Pharmacometrics; Oseltamivir; PK/PD
PMID: 28176362 DOI: 10.1111/bcp.13229
[PubMed - as supplied by publisher]