Abstract
OBJECTIVE: To determine the cost-effectiveness of rapid diagnostic testing and empiric antiviral therapy for healthy adults with symptoms of influenza.
DESIGN: Cost-effectiveness analysis using a decision model based on previously published data. Outcome measures included costs and quality-adjusted life expectancy.
SETTING: Physician’s office.
PATIENTS/PARTICIPANTS: Hypothetically healthy, working adults < 65 years of age presenting with cough and fever during the influenza season.
INTERVENTIONS: Rapid testing or clinical diagnosis followed by treatment with amantadine, rimantadine, oseltamivir, or zanamivir compared with no antiviral therapy.
RESULTS: Base-case analysis: not giving antiviral therapy is the most expensive and least effective strategy, costing $471 per patient, mostly owing to time lost from work. Amantadine treatment increases life expectancy by 0.0014 quality-adjusted life years (QALYs) while saving $108 per patient relative to no antiviral therapy. Zanamivir is slightly more effective than amantadine, adding 0.0002 QALYs at an incremental cost of $31, or $133,000 per QALY saved. All other strategies, including testing strategies, are both less effective and more expensive.
SENSITIVITY ANALYSIS: The model is sensitive to the probability of influenza infection, proportion of influenza caused by type B, the relative efficacy of the various drugs, and the value of a workday. At a clinical probability of influenza infection >20%, antiviral therapy is favored. As the proportion of influenza B increases, zanamivir is favored over amantadine. Testing is rarely indicated. Ignoring the costs of lost workdays, amantadine treatment costs $1,200/QALY saved.
CONCLUSIONS: Antiviral therapy with either amantadine or zanamivir is cost-effective for healthy, young patients with influenza-like illness during the influenza season, depending on the prevalence of influenza B.
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Rothberg, M.B., He, S. & Rose, D.N. Management of influenza symptoms in healthy adults. J GEN INTERN MED 18, 808–815 (2003). https://doi.org/10.1046/j.1525-1497.2003.20822.x
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DOI: https://doi.org/10.1046/j.1525-1497.2003.20822.x