Clinical Drug Investigation

, Volume 24, Issue 7, pp 395–407 | Cite as

Effect of Influenza Treatment with Oseltamivir on Health Outcome and Costs in Otherwise Healthy Children

  • Keith Reisinger
  • Gerald Greene
  • Rick Aultman
  • Beate Sander
  • Marlene Gyldmark
Original Research Article

Abstract

Objective

To evaluate the effect of treating children with influenza with oseltamivir on health outcomes and costs to healthcare payers.

Patients and design

Health outcome data from the oseltamivir paediatric clinical development programme plus data from the literature were used in an economic model developed to predict morbidity and mortality due to influenza and its specified complications. Published data on the cost of care in the UK were used to compare oseltamivir with usual care in children aged 1–12 and 1–5 years by estimating cost-effectiveness and cost-utility ratios.

Results

Oseltamivir reduced median time to return to normal health and activity by almost 2 days (40% reduction, 67.1 vs 111.7 hours; p < 0.0001) versus placebo. In children aged 1–5 years, a 48% reduction (63.5 vs 121.3 hours; p = 0.0003) was observed. Oseltamivir-treated children who developed otitis media returned to normal health and activity 30% faster (99.6 vs 141.5 hours; p = 0.0517) than the placebo group. In the economic model, oseltamivir in the base-case analysis (assuming 60% diagnostic accuracy, full compliance, and 100% receive and start treatment within 48 hours, standard discounting according to the UK National Institute of Clinical Excellence guidelines) resulted in favourable cost-utility ratios in children aged both 1–12 and 1–5 years, with incremental cost-utility rates of £11 173/quality-adjusted life year (QALY) and oseltamivir being dominant compared with usual care, respectively (year of costing, 2002). Even in conservative scenarios, most cost-utility ratios remained <£30 000/QALY.

Conclusions

Oseltamivir is an effective treatment for children with influenza, allowing faster return to normal health and activity compared with usual care. From the healthcare payer perspective, oseltamivir is a potentially cost-effective strategy for otherwise healthy children.

References

  1. 1.
    Meier CR, Napalkov PN, Wegmuller Y, et al. Population-based study on incidence, risk factors, clinical complications and drug utilisation associated with influenza in the United Kingdom. Eur J Clin Microbiol Infect Dis 2000; 19: 834–42PubMedCrossRefGoogle Scholar
  2. 2.
    Whitley RJ, Hayden FG, Reisinger KS, et al. Oral oseltamivir treatment of influenza in children. Pediatr Infect Dis J 2001; 20: 127–33PubMedCrossRefGoogle Scholar
  3. 3.
    Altemeier WA. Children and influenza outbreaks. Pediatr Ann 2000; 29: 670–1PubMedGoogle Scholar
  4. 4.
    Fox JP, Cooney MK, Hall CE, et al. Influenza virus infections in Seattle families, 1975–1979. II. Pattern of infection in invaded households and relation of age and prior antibody to occurrence of infection and related illness. Am J Epidemiol 1982; 116: 228–42PubMedGoogle Scholar
  5. 5.
    Nicholson KG. Human influenza. In: Nicholson KG, Webster RG, Hay AJ, eds. Textbook of influenza. Oxford, UK: Blackwell, 1998: 219–64Google Scholar
  6. 6.
    Belshe RB, Mendelman PM, Treanor J, et al. The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenzavirus vaccine in children. N Engl J Med 1998; 338: 1405–12PubMedCrossRefGoogle Scholar
  7. 7.
    Neuzil KM, Meilen BG, Wright PF, et al. The effect of influenza on hospitalisations, outpatient visits, and courses of antibiotics in children. N Engl J Med 2000; 342: 225–31PubMedCrossRefGoogle Scholar
  8. 8.
    Izurieta HS, Thompson WW, Kramarz P, et al. Influenza and the rates of hospitalisation for respiratory disease among infants and young children. N Engl J Med 2000; 342: 232–9PubMedCrossRefGoogle Scholar
  9. 9.
    Arden NH. The epidemiology of influenza in children. Pediatr Ann 2000; 29: 678–82PubMedGoogle Scholar
  10. 10.
    Szucs T. The socio-economic burden of influenza. J Antimicrob Chemother 1999; 44 Suppl. B: 11–5PubMedCrossRefGoogle Scholar
  11. 11.
    Levy E. French economic evaluations of influenza and influenza vaccination. Pharmacoeconomics 1996; 9 Suppl. 3: 62–6PubMedCrossRefGoogle Scholar
  12. 12.
    Keech M, Scott AJ, Ryan PJ. The impact of influenza and influenza-like illness on productivity and healthcare resource utilisation in a working population. Occup Med (Lond) 1998; 48: 85–90CrossRefGoogle Scholar
  13. 13.
    Chung EK, Casey R, Pinto-Martin JA, et al. Routine and influenza vaccination rates in children with asthma. Ann Allergy Asthma Immunol 1998; 80: 318–22PubMedCrossRefGoogle Scholar
  14. 14.
    Neuzil KM, Wright PF, Mitchel EF, et al. The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr 2000; 137: 856–64PubMedCrossRefGoogle Scholar
  15. 15.
    Bryson YJ. The use of amantadine in children for prophylaxis and treatment of influenza A infections. Pediatr Infect Dis 1982; 1: 44–6PubMedCrossRefGoogle Scholar
  16. 16.
    Englund JA. Antiviral therapy of influenza. Semin Pediatr Infect Dis 2002; 13: 120–8PubMedCrossRefGoogle Scholar
  17. 17.
    Treanor JJ, Hayden FG, Vrooman PS, et al. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomised controlled trial. US Oral Neuraminidase Study Group. JAMA 2000; 283: 1016–24PubMedCrossRefGoogle Scholar
  18. 18.
    Nicholson KG, Aoki FY, Osterhaus AD, et al. Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial. Neuraminidase Inhibitor Flu Treatment Investigator Group. Lancet 2000; 355: 1845–50PubMedCrossRefGoogle Scholar
  19. 19.
    Aoki FY, Macleod MD, Paggiaro P, et al. Early administration of oral oseltamivir maximises the benefits of influenza treatment. J Antimicrob Chemother 2003; 51(1): 123–9PubMedCrossRefGoogle Scholar
  20. 20.
    Martin C, Mahoney P, Ward P. Oral oseltamivir reduces febrile illness in patients considered at high risk of influenza complications. Int Congr Ser. 1219: 807-811. Osterhaus A, Cox N, Hampson A, editors. World Congress on Options for the Control of Influenza IV, Crete, Greece, 2000 Sep 23-28Google Scholar
  21. 21.
    Hayden FG, Atmar RL, Schilling M, et al. Use of the selective oral neuraminidase inhibitor oseltamivir to prevent influenza. N Engl J Med 1999; 341: 1336–43PubMedCrossRefGoogle Scholar
  22. 22.
    Peters Jr PH, Gravenstein S, Norwood P, et al. Long-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population. J Am Geriatr Soc 2001; 49: 1025–31PubMedCrossRefGoogle Scholar
  23. 23.
    Welliver R, Monto AS, Carewicz O, et al. Effectiveness of oseltamivir in preventing influenza in household contacts: a randomised controlled trial. JAMA 2001; 285: 748–54PubMedCrossRefGoogle Scholar
  24. 24.
    National Institute for Clinical Excellence. Guidance for manufacturers and sponsors. London: Technological Appraisals Process Series 5, 2001Google Scholar
  25. 25.
    Simonsen L, Fukuda K, Schonberger LB, et al. The impact of influenza epidemics on hospitalisations. J Infect Dis 2000; 181: 831–7PubMedCrossRefGoogle Scholar
  26. 26.
    Bochud PY, Moser F, Erard P, et al. Community-acquired pneumonia: a prospective outpatient study. Medicine (Baltimore) 2001; 80(2): 75–87CrossRefGoogle Scholar
  27. 27.
    Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003; 289(2): 179–86PubMedCrossRefGoogle Scholar
  28. 28.
    Die Spitäler der Schweiz. H+ Spitalstatistiken, Medizinische Gesamtstatistik der Schweizer Spitäler 1996. H+ Verlag CH-5001 Aarau, 1997Google Scholar
  29. 29.
    Netten A, Rees T, Harrison G. Unit costs of health and social care. Personal Social Services Research Unit at the University of Kent at Canterbury, the London School of Economics and the University of Manchester. Canterbury, UK, University of Kent at Canterbury, 2001 Dec. Available from URL: http//www.ukc.ac.uk/PSSRU [Accessed 2002 Feb]Google Scholar
  30. 30.
    British National Formulary No [41]. British Medical Association & Royal Pharmaceutical Society of Great Britain. Available from URL: http//www.bnf.org [Accessed 2001 Nov]Google Scholar
  31. 31.
    Department of Health and Human Services. National Ambulatory Medical Care Survey (NAMCS). National Center for Health Statistics NCHS 1997. Available from URL: http//www.cdc.gov/nchs/about/major/ahcd/namcsdes.htm [Accessed 2002 Feb]Google Scholar
  32. 32.
    Schwarzinger M, Housset B, Carrat F. Bedside rapid flu test and zanamivir prescription in healthy working adults: a cost-benefit analysis. Pharmacoeconomics 2003; 21: 215–24PubMedCrossRefGoogle Scholar
  33. 33.
    Stouthard M, Essink-Bot M, Bonsel G, et al. Disability weights for diseases in the Netherlands. Department of Public Health, Erasmus University, Rotterdam, The Netherlands: 1997Google Scholar
  34. 34.
    National Institute for Clinical Excellence. Guidance on the use of zanamivir (Relenza) in the treatment of influenza. NICE Technology Appraisal Guidance -No 15. Ref: 22603. London: NICE, 2000 Nov. Available from URL: http://www.nice.org.uk and http://www.nice.org.uk/pdf/NiceZANAMIVIR15guidance.pdf [Accessed 2002 Feb]
  35. 35.
    Hedrick JA, Barzilai A, Behre U, et al. Zanamivir for treatment of symptomatic influenza A and B in children five to twelve years of age: a randomised controlled trial. Pediatr Infect Dis J 2000; 19: 410–7PubMedCrossRefGoogle Scholar
  36. 36.
    Griffin AD, Perry AS, Fleming DM. Cost-effectiveness analysis of inhaled zanamivir in the treatment of influenza A and B in high-risk patients. Pharmacoeconomics 2001; 19: 293–301PubMedCrossRefGoogle Scholar
  37. 37.
    Mauskopf JA, Cates SC, Griffin AD, et al. Cost effectiveness of zanamivir for the treatment of influenza in a high risk population in Australia. Pharmacoeconomics. 2000; 17: 611–20PubMedCrossRefGoogle Scholar
  38. 38.
    Watanabe A, Kobayashi M. Socioeconomic analysis of oseltamivir for influenza patients. Jpn J Chemother 2001; 49: 95–102Google Scholar
  39. 39.
    Armstrong E, Khan Z, Perry A, et al. The cost effectiveness of zanamivir and oseltamivir for influenza treatment. Formulary 2000; 35: 979–89Google Scholar
  40. 40.
    Burls A, Clark W, Stewart T, et al. Zanamivir for the treatment of influenza in adults [Draft]. Commissioned by National Health Service Health Technology Assessment Programme on behalf of National Institute for Clinical Excellence. West Midlands Development and Evaluation Service, University of Birmingham; 2000 Jun. Available from URL: http://www.nice.org.uk/pdf/zanamivirtreatment.pdf [Accessed 2002 Feb]
  41. 41.
    Hussereau DR, Brady B, McGeer A. Oseltamivir for the treatment of suspected influenza: a clinical and economic assessment. Canadian Coordinating Office for Health Technology Assessment, 2001 Nov. Available from URL: http://www.cchota.ca [Accessed 2002 Feb]
  42. 42.
    Scuffam PA, West PA. Economic evaluation of strategies for the control and management of influenza in Europe. Vaccine 2002; 20: 2562–78CrossRefGoogle Scholar
  43. 43.
    Muenning PA, Khan K. Cost-effectiveness of vaccination versus treatment of influenza in healthy adolescents and adults. Clin Infect Dis 2001; 33: 1879–85CrossRefGoogle Scholar
  44. 44.
    Brady B, McAuley L, Shukla VK. Economic evaluation of zanamivir for the treatment of influenza. Canadian Coordinating Office for Health Technology Assessment, 2001 Nov. Available from URL: http://www.cchota.ca [Accessed 2002 Feb]
  45. 45.
    Sander B, Gyldmark M. Impact of different methods of QALY calculations on CUA results and decision-making -the case of influenza treatment with neuraminidase inhibitors. Eur J Health Econ. In pressGoogle Scholar
  46. 46.
    Ross AM, Kai J, Salter R, et al. Presentation with influenza-like illness in general practice: implications for use of neuraminidase inhibitors. Commun Dis Public Health 2000; 3: 256–60PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Keith Reisinger
    • 1
  • Gerald Greene
    • 2
  • Rick Aultman
    • 3
  • Beate Sander
    • 4
  • Marlene Gyldmark
    • 3
  1. 1.Primary Physicians ResearchPittsburghUSA
  2. 2.Arrowhead Regional Medical CenterColtonUSA
  3. 3.Pharmaceuticals DivisionF. Hoffmann-La Roche LtdBaselSwitzerland
  4. 4.Institute for Medical Outcome ResearchLoerrachGermany

Personalised recommendations