Rothberg Michael B, Bellantonio Sandra, Rose David N
Division of General Medicine and Geriatrics, Baystate Medical Center, Springfield, MA 01199, USA.
Ann Intern Med. 2003 Sep 2;139(5 Pt 1):321-9. doi: 10.7326/0003-4819-139-5_part_1-200309020-00007.
Although antiviral therapy is cost-effective in adults, its cost-effectiveness in older adults has not been studied.
To determine the cost-effectiveness of influenza testing and treatment strategies for older adults.
Cost-utility decision model.
Clinical trials of antiviral drugs and epidemiologic data.
Noninstitutionalized adults older than 65 years of age with influenza-like illness.
Lifetime.
Societal.
Rapid diagnostic testing or empirical therapy with antiviral drugs.
Cost per quality-adjusted life-year (QALY) saved.
RESULTS OF BASE-CASE ANALYSIS: Compared with no intervention, empirically treating an unvaccinated 75-year-old patient with amantadine increased life expectancy by 0.0014 QALY at a cost of 1.57 dollars, a cost-effectiveness ratio of 1129 dollars per QALY saved. Compared with amantadine, rapid diagnostic testing followed by treatment with oseltamivir cost 5025 dollars per QALY saved and empirical treatment with oseltamivir cost 10,296 dollars per QALY saved. Testing and treatment strategies were less cost-effective if the patient was vaccinated, ranging from 2483 dollars per QALY saved with amantadine to 70,300 dollars per QALY saved with oseltamivir.
The decision was sensitive to the probability of influenza, the efficacy of oseltamivir in preventing hospitalizations, and hospitalization and case-fatality rates. The decision was not sensitive to the probability or severity of medication side effects, the quality of life for influenza illness or hospitalization, the efficacy of antiviral therapy in shortening influenza illness, or the rapid diagnostic test characteristics.
For unvaccinated or high-risk vaccinated patients during the influenza season, empirical oseltamivir treatment is cost-effective. For other patients, rapid diagnostic testing followed by treatment with oseltamivir is cost-effective. Empirical amantadine treatment offers a low-cost alternative if patients cannot afford oseltamivir.
尽管抗病毒治疗在成年人中具有成本效益，但其在老年人中的成本效益尚未得到研究。
确定老年人流感检测和治疗策略的成本效益。
成本效用决策模型。
抗病毒药物的临床试验和流行病学数据。
65岁以上患有流感样疾病的非机构化成年人。
终身。
社会。
快速诊断检测或使用抗病毒药物进行经验性治疗。
每挽救一个质量调整生命年（QALY）的成本。
与不进行干预相比，用金刚烷胺对一名未接种疫苗的75岁患者进行经验性治疗可使预期寿命增加0.0014个QALY，成本为1.57美元，每挽救一个QALY的成本效益比为1129美元。与金刚烷胺相比，先进行快速诊断检测然后用奥司他韦治疗，每挽救一个QALY的成本为5025美元，而用奥司他韦进行经验性治疗，每挽救一个QALY的成本为10296美元。如果患者接种了疫苗，检测和治疗策略的成本效益较低，从用金刚烷胺每挽救一个QALY的成本为2483美元到用奥司他韦每挽救一个QALY的成本为70300美元不等。
该决策对流感的概率、奥司他韦预防住院的疗效以及住院率和病死率敏感。该决策对药物副作用的概率或严重程度、流感疾病或住院的生活质量、抗病毒治疗缩短流感疾病的疗效或快速诊断检测特征不敏感。
对于流感季节未接种疫苗或高危接种疫苗的患者，经验性使用奥司他韦治疗具有成本效益。对于其他患者，先进行快速诊断检测然后用奥司他韦治疗具有成本效益。如果患者负担不起奥司他韦，经验性使用金刚烷胺治疗是一种低成本的选择。
