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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 test-treat strategy over the treat only strategy to A) near-test sensitivity and specificity and B) near-test unit cost and shelf-life. The test-treat program becomes cost-effective below the cost-effectiveness threshold (£30,000 per quality-adjusted life year [QALY] gained).
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Figure 3: Univariate sensitivity analyses of the incremental cost-effectiveness of the test-treat strategy over the treat only strategy to A) near-test sensitivity and specificity and B) near-test unit cost and shelf-life. The test-treat program becomes cost-effective below the cost-effectiveness threshold (£30,000 per quality-adjusted life year [QALY] gained).

Mentions: For high CARs, where a fixed AV drug stockpile is less than the expected demand (as in the base-case), near-patient tests could be used to better target therapeutic courses. A univariate sensitivity analysis of the incremental cost-effectiveness of test-treat over treat only to variability in the near-patient test parameters, test sensitivity, specificity, unit cost, and shelf-life, was carried out. Under the 1918 scenario the test-treat strategy would require test sensitivity to exceed ≈90% (Figure 3, panel A) and a test unit cost below £6 or a shelf-life above 3 years (Figure 3, panel B) to be considered cost-effective. Test specificity would have little effect on the incremental cost-effectiveness because it has no effect on QALY loss. Under the 1957/69 scenario test-treat would never cross the cost-effectiveness threshold even with a 100%-sensitive or 100%-specific test, a test cost as low as £0, or a shelf-life as high as 4 years.


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 test-treat strategy over the treat only strategy to A) near-test sensitivity and specificity and B) near-test unit cost and shelf-life. The test-treat program becomes cost-effective below the cost-effectiveness threshold (£30,000 per quality-adjusted life year [QALY] gained).
© Copyright Policy
Related In: Results  -  Collection

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

Figure 3: Univariate sensitivity analyses of the incremental cost-effectiveness of the test-treat strategy over the treat only strategy to A) near-test sensitivity and specificity and B) near-test unit cost and shelf-life. The test-treat program becomes cost-effective below the cost-effectiveness threshold (£30,000 per quality-adjusted life year [QALY] gained).
Mentions: For high CARs, where a fixed AV drug stockpile is less than the expected demand (as in the base-case), near-patient tests could be used to better target therapeutic courses. A univariate sensitivity analysis of the incremental cost-effectiveness of test-treat over treat only to variability in the near-patient test parameters, test sensitivity, specificity, unit cost, and shelf-life, was carried out. Under the 1918 scenario the test-treat strategy would require test sensitivity to exceed ≈90% (Figure 3, panel A) and a test unit cost below £6 or a shelf-life above 3 years (Figure 3, panel B) to be considered cost-effective. Test specificity would have little effect on the incremental cost-effectiveness because it has no effect on QALY loss. Under the 1957/69 scenario test-treat would never cross the cost-effectiveness threshold even with a 100%-sensitive or 100%-specific test, a test cost as low as £0, or a shelf-life as high as 4 years.

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