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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

Optimal cost-effectiveness of antiviral (AV) and test stockpiling (0–30 million units) for a clinical attack rate (CAR) of 25% under the A) 1918 and B) 1957/69 scenarios. The composite test (Test A) and a perfect test of 100% sensitivity and 100% specificity (Test B) are included. The most cost-effective strategies lie on the efficiency line. ILI, influenza-like illness; QALY, quality-adjusted life year.
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Figure 6: Optimal cost-effectiveness of antiviral (AV) and test stockpiling (0–30 million units) for a clinical attack rate (CAR) of 25% under the A) 1918 and B) 1957/69 scenarios. The composite test (Test A) and a perfect test of 100% sensitivity and 100% specificity (Test B) are included. The most cost-effective strategies lie on the efficiency line. ILI, influenza-like illness; QALY, quality-adjusted life year.

Mentions: In the long term, it may be more cost-effective to increase stockpiles to cover expected demand (CAR + background ILI + wastage). Figure 6 and the Appendix Figure show the expected costs and QALY losses under a range of different AV drug and test stockpiles and CARs (base-case test characteristics and AV drug efficacy assumed). Each point represents 1 scenario (test and AV drug stockpile size). Points on the efficiency line were potentially cost-effective strategies. Strategies that increase cost but reduce QALY loss (moving from left to right on the efficiency line) should be considered until the slope of the line exceeds the threshold of £30,000 per QALY (efficiency line ends). For each CAR, this process suggested that the optimal strategy was treat only, stockpiling enough AV drugs to meet demand (CAR plus background ILI plus AV drug wastage). Therefore, for a CAR of 25%, the optimum stockpile was ≈20 million AV drugs only (Figure 6) because the expected number of ILI cases would be 16.8 million (15 million of which would be pandemic influenza) and the expected AV drug wastage would be 2.2 million. The test-treat strategies were never on the efficiency line, even for a perfect test (100% sensitivity and specificity), because they resulted in similar QALY loss as treat only but at increased costs. Indeed, when the size of the AV drug stockpile exceeded the demand, test-treat resulted in increased QALY loss (if the test is not 100% sensitive), because some true pandemic influenza case-patients would be denied treatment even though there was a surplus of AV drug courses.


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

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

Optimal cost-effectiveness of antiviral (AV) and test stockpiling (0–30 million units) for a clinical attack rate (CAR) of 25% under the A) 1918 and B) 1957/69 scenarios. The composite test (Test A) and a perfect test of 100% sensitivity and 100% specificity (Test B) are included. The most cost-effective strategies lie on the efficiency line. ILI, influenza-like illness; QALY, quality-adjusted life year.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 6: Optimal cost-effectiveness of antiviral (AV) and test stockpiling (0–30 million units) for a clinical attack rate (CAR) of 25% under the A) 1918 and B) 1957/69 scenarios. The composite test (Test A) and a perfect test of 100% sensitivity and 100% specificity (Test B) are included. The most cost-effective strategies lie on the efficiency line. ILI, influenza-like illness; QALY, quality-adjusted life year.
Mentions: In the long term, it may be more cost-effective to increase stockpiles to cover expected demand (CAR + background ILI + wastage). Figure 6 and the Appendix Figure show the expected costs and QALY losses under a range of different AV drug and test stockpiles and CARs (base-case test characteristics and AV drug efficacy assumed). Each point represents 1 scenario (test and AV drug stockpile size). Points on the efficiency line were potentially cost-effective strategies. Strategies that increase cost but reduce QALY loss (moving from left to right on the efficiency line) should be considered until the slope of the line exceeds the threshold of £30,000 per QALY (efficiency line ends). For each CAR, this process suggested that the optimal strategy was treat only, stockpiling enough AV drugs to meet demand (CAR plus background ILI plus AV drug wastage). Therefore, for a CAR of 25%, the optimum stockpile was ≈20 million AV drugs only (Figure 6) because the expected number of ILI cases would be 16.8 million (15 million of which would be pandemic influenza) and the expected AV drug wastage would be 2.2 million. The test-treat strategies were never on the efficiency line, even for a perfect test (100% sensitivity and specificity), because they resulted in similar QALY loss as treat only but at increased costs. Indeed, when the size of the AV drug stockpile exceeded the demand, test-treat resulted in increased QALY loss (if the test is not 100% sensitive), because some true pandemic influenza case-patients would be denied treatment even though there was a surplus of AV drug courses.

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