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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

Incremental cost-effectiveness of the test-treat strategy over the treat-only strategy during a pandemic wave (antiviral [AV] stockpile = 14.6 million courses, test stockpile = number of cumulative influenza-like [ILI] cases, clinical attack rate = 25%). QALY, quality-adjusted life year.
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Figure 5: Incremental cost-effectiveness of the test-treat strategy over the treat-only strategy during a pandemic wave (antiviral [AV] stockpile = 14.6 million courses, test stockpile = number of cumulative influenza-like [ILI] cases, clinical attack rate = 25%). QALY, quality-adjusted life year.

Mentions: The AV drug stockpile was assumed to remain fixed at 14.6 million courses (1), and the test stockpile was varied with the cumulative number of ILI cases expected per week of the pandemic wave. Figure 5 shows the total incremental cost-effectiveness of the test-treat strategy over treat only for each test stockpile for a CAR of 25%. Test-treat would be cost-effective (<£30,000 per QALY gained) for test stockpiles up to 12.1 million (the expected no. of cumulative ILI cases at wk 8 of a pandemic) under the 1918 scenario. Test-treat may even be considered for test stockpiles up to 13.7 million (wk 9 of a pandemic) as the cost-effectiveness was ≈£32,700 per QALY gained. However, under the 1957/69 scenario test-treat would not be cost-effective at any stage of the pandemic, although it may be considered for test stockpiles up to ≈35,000 (wk 2 of a pandemic) as the cost was ≈£34,000 per QALY gained.


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

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

Incremental cost-effectiveness of the test-treat strategy over the treat-only strategy during a pandemic wave (antiviral [AV] stockpile = 14.6 million courses, test stockpile = number of cumulative influenza-like [ILI] cases, clinical attack rate = 25%). QALY, quality-adjusted life year.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 5: Incremental cost-effectiveness of the test-treat strategy over the treat-only strategy during a pandemic wave (antiviral [AV] stockpile = 14.6 million courses, test stockpile = number of cumulative influenza-like [ILI] cases, clinical attack rate = 25%). QALY, quality-adjusted life year.
Mentions: The AV drug stockpile was assumed to remain fixed at 14.6 million courses (1), and the test stockpile was varied with the cumulative number of ILI cases expected per week of the pandemic wave. Figure 5 shows the total incremental cost-effectiveness of the test-treat strategy over treat only for each test stockpile for a CAR of 25%. Test-treat would be cost-effective (<£30,000 per QALY gained) for test stockpiles up to 12.1 million (the expected no. of cumulative ILI cases at wk 8 of a pandemic) under the 1918 scenario. Test-treat may even be considered for test stockpiles up to 13.7 million (wk 9 of a pandemic) as the cost-effectiveness was ≈£32,700 per QALY gained. However, under the 1957/69 scenario test-treat would not be cost-effective at any stage of the pandemic, although it may be considered for test stockpiles up to ≈35,000 (wk 2 of a pandemic) as the cost was ≈£34,000 per QALY gained.

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