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Cost-effectiveness of antiviral stockpiling and near-patient testing for potential influenza pandemic.

Siddiqui MR, Edmunds WJ - Emerging Infect. Dis. (2008)

Bottom Line: A decision analytical model was developed to investigate the cost-effectiveness of stockpiling antiviral (AV) drugs for a potential influenza pandemic in the United Kingdom and the possible role of near-patient testing in conserving AV drug stocks.Under base-case assumptions (including a fixed stockpile that was smaller than the clinical attack rate), the treat-only option (treating all symptomatic patients with AV drugs) would be considered cost-effective ( pound1,900- pound13,700 per quality-adjusted life year [QALY] gained, depending on the fatality scenario), compared with no intervention (nonintervention but management of cases as they arise).Stockpiling sufficient AV drugs (but not near-patient tests) to treat all patients with clinical cases would be cost-effective, provided AV drugs are effective at preventing deaths from pandemic influenza.

View Article: PubMed Central - PubMed

Affiliation: Health Protection Agency, London, UK. ruby.siddiqui@hpa.org.uk

ABSTRACT
A decision analytical model was developed to investigate the cost-effectiveness of stockpiling antiviral (AV) drugs for a potential influenza pandemic in the United Kingdom and the possible role of near-patient testing in conserving AV drug stocks. Under base-case assumptions (including a fixed stockpile that was smaller than the clinical attack rate), the treat-only option (treating all symptomatic patients with AV drugs) would be considered cost-effective ( pound1,900- pound13,700 per quality-adjusted life year [QALY] gained, depending on the fatality scenario), compared with no intervention (nonintervention but management of cases as they arise). The test-treat option (testing all symptomatic patients but treating those with positive tests results only) would result in moderate gains in QALYs over the treat-only option but at relatively large additional costs. Stockpiling sufficient AV drugs (but not near-patient tests) to treat all patients with clinical cases would be cost-effective, provided AV drugs are effective at preventing deaths from pandemic influenza.

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Related in: MedlinePlus

Univariate sensitivity analyses of the incremental cost-effectiveness of the treat only strategy over the no-intervention strategy to model parameters under the 1918 scenario (A) and 1957/69 scenario (B). OR, odds ratio; AV, antiviral; CAR, clinical attack rate; ILI, influenza-like illness; A&E, accident and emergency department; GP, general practitioner; QALY, quality-adjusted life year.
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Figure 2: Univariate sensitivity analyses of the incremental cost-effectiveness of the treat only strategy over the no-intervention strategy to model parameters under the 1918 scenario (A) and 1957/69 scenario (B). OR, odds ratio; AV, antiviral; CAR, clinical attack rate; ILI, influenza-like illness; A&E, accident and emergency department; GP, general practitioner; QALY, quality-adjusted life year.

Mentions: Because the treat-only program was the most cost-effective program under both fatality scenarios, we carried out a univariate sensitivity analysis of the incremental cost-effectiveness of this program to variability in model parameters (Appendix Table). AV drug efficacy for reducing complications and hospitalizations had minimal effect on the cost-effectiveness of the treat-only program, but this strategy was highly sensitive to AV drug efficacy for reducing death (Figure 2). This was due to the relatively high QALY loss associated with pandemic influenza death (94% and 69% of the total QALY loss for the 1918 and 1957/69 scenarios, respectively). Because the value of this parameter is unclear, further studies of the potential protective effect of AV drugs against death are essential.


Cost-effectiveness of antiviral stockpiling and near-patient testing for potential influenza pandemic.

Siddiqui MR, Edmunds WJ - Emerging Infect. Dis. (2008)

Univariate sensitivity analyses of the incremental cost-effectiveness of the treat only strategy over the no-intervention strategy to model parameters under the 1918 scenario (A) and 1957/69 scenario (B). OR, odds ratio; AV, antiviral; CAR, clinical attack rate; ILI, influenza-like illness; A&E, accident and emergency department; GP, general practitioner; QALY, quality-adjusted life year.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2600182&req=5

Figure 2: Univariate sensitivity analyses of the incremental cost-effectiveness of the treat only strategy over the no-intervention strategy to model parameters under the 1918 scenario (A) and 1957/69 scenario (B). OR, odds ratio; AV, antiviral; CAR, clinical attack rate; ILI, influenza-like illness; A&E, accident and emergency department; GP, general practitioner; QALY, quality-adjusted life year.
Mentions: Because the treat-only program was the most cost-effective program under both fatality scenarios, we carried out a univariate sensitivity analysis of the incremental cost-effectiveness of this program to variability in model parameters (Appendix Table). AV drug efficacy for reducing complications and hospitalizations had minimal effect on the cost-effectiveness of the treat-only program, but this strategy was highly sensitive to AV drug efficacy for reducing death (Figure 2). This was due to the relatively high QALY loss associated with pandemic influenza death (94% and 69% of the total QALY loss for the 1918 and 1957/69 scenarios, respectively). Because the value of this parameter is unclear, further studies of the potential protective effect of AV drugs against death are essential.

Bottom Line: A decision analytical model was developed to investigate the cost-effectiveness of stockpiling antiviral (AV) drugs for a potential influenza pandemic in the United Kingdom and the possible role of near-patient testing in conserving AV drug stocks.Under base-case assumptions (including a fixed stockpile that was smaller than the clinical attack rate), the treat-only option (treating all symptomatic patients with AV drugs) would be considered cost-effective ( pound1,900- pound13,700 per quality-adjusted life year [QALY] gained, depending on the fatality scenario), compared with no intervention (nonintervention but management of cases as they arise).Stockpiling sufficient AV drugs (but not near-patient tests) to treat all patients with clinical cases would be cost-effective, provided AV drugs are effective at preventing deaths from pandemic influenza.

View Article: PubMed Central - PubMed

Affiliation: Health Protection Agency, London, UK. ruby.siddiqui@hpa.org.uk

ABSTRACT
A decision analytical model was developed to investigate the cost-effectiveness of stockpiling antiviral (AV) drugs for a potential influenza pandemic in the United Kingdom and the possible role of near-patient testing in conserving AV drug stocks. Under base-case assumptions (including a fixed stockpile that was smaller than the clinical attack rate), the treat-only option (treating all symptomatic patients with AV drugs) would be considered cost-effective ( pound1,900- pound13,700 per quality-adjusted life year [QALY] gained, depending on the fatality scenario), compared with no intervention (nonintervention but management of cases as they arise). The test-treat option (testing all symptomatic patients but treating those with positive tests results only) would result in moderate gains in QALYs over the treat-only option but at relatively large additional costs. Stockpiling sufficient AV drugs (but not near-patient tests) to treat all patients with clinical cases would be cost-effective, provided AV drugs are effective at preventing deaths from pandemic influenza.

Show MeSH
Related in: MedlinePlus