Department of Pharmacy, St Luke’s International Hospital, Tokyo, Japan.
Clin Drug Investig. 2005;25(1):49-63. doi: 10.2165/00044011-200525010-00005.
We constructed a cost-effectiveness decision model to determine a hypothetical 'best treatment' pathway for patients presenting at our institution with influenza virus infection when the choice of treatment was either oseltamivir, zanamivir or a control therapy not active against influenza.
The decision model was constructed using DATA 3.5 for evaluating the cost-effectiveness analysis of neuraminidase inhibitors from the perspective of the healthcare payer. The time horizon was set at 14 days based on the general duration of influenza infection in Japan. Clinical outcomes were mainly derived from reports and guidance published by the National Institute for Clinical Excellence in the UK. Japan-specific cost parameters incorporated into the decision model were taken from the Medical Fee Point Survey conducted at St Luke's International Hospital in accordance with medical fee receipts kept at our institution. The study included four professionals and a supporter who gathered information required for the analysis.
In otherwise healthy adults, cost savings of yen831.6 (approximately $US6.72; 2002 values) in the oseltamivir group and an increment in cost of yen40.5 (approximately $US0.33) in the zanamivir group were achieved in comparison with the control group. In contrast, an incremental cost of yen288.4 (approximately $US2.33) was incurred in the oseltamivir group versus the control group when at-risk patients were assessed, but cost savings of yen159.8 (approximately $US1.29) were achieved in the zanamivir group. As a result of cost-effectiveness and cost-utility analyses in otherwise healthy adults, oseltamivir dominated the control therapy because cost savings in the oseltamivir group were made. In the zanamivir group the cost was incremental and the Incremental Cost-Utility Ratio (ICUR) compared with the control group was about yen13 000 (approximately $US107.34)/quality-adjusted life-year (QALY) gained. As a result of cost-effectiveness and cost-utility analyses in at-risk patients, in the oseltamivir group the cost was incremental and the ICUR compared with the control group was about yen230 000 (approximately $US2138.77)/QALY gained. As cost savings were made, zanamivir dominated the control therapy.
While the cost effectiveness (from the perspective of a healthcare payer) of the neuraminidase inhibitors was superior to that of the control group in the treatment of otherwise healthy adults with influenza in our study, it seemed necessary to take other factors into consideration before recommending one agent over the other as a first-line therapy. On the other hand, we suggest that zanamivir is the drug of choice for use in at-risk patients, and we recommend, in the light of our results, that if zanamivir is not available another therapy should be given rather than oseltamivir. Since with influenza infections deaths and hospitalisations of at-risk patients impact on the Japanese community, decision-making on the appropriate therapy should take into account the particular patient group involved.
我们构建了一个成本效益决策模型，以确定在我们的机构中出现流感病毒感染的患者的假设“最佳治疗”途径，治疗选择为奥司他韦、扎那米韦或对流感无效的对照治疗。
该决策模型是使用 DATA 3.5 构建的，用于从医疗保健支付者的角度评估神经氨酸酶抑制剂的成本效益分析。时间范围设定为 14 天，这是基于日本流感感染的一般持续时间。临床结果主要来自英国国家临床卓越研究所发布的报告和指南。决策模型中纳入的日本特定成本参数是根据圣卢克国际医院进行的医疗费用点调查得出的，该调查符合我们机构保存的医疗费用收据。该研究包括四名专业人员和一名支持者，他们收集了分析所需的信息。
在健康成年人中，与对照组相比，奥司他韦组节省了 831.6 日元（约合 6.72 美元；2002 年的价值），而扎那米韦组的成本增加了 40.5 日元（约合 0.33 美元）。相比之下，在评估高危患者时，奥司他韦组的增量成本为 288.4 日元（约合 2.33 美元），而对照组的成本节省了 159.8 日元（约合 1.29 美元）。在健康成年人中进行成本效益和成本效用分析的结果表明，奥司他韦优于对照组，因为奥司他韦组节省了成本。在扎那米韦组中，成本是递增的，与对照组相比，增量成本效用比（ICUR）约为 13000 日元（约合 107.34 美元）/每获得一个质量调整生命年（QALY）。在高危患者中进行成本效益和成本效用分析的结果表明，奥司他韦组的成本是递增的，与对照组相比，ICUR 约为 230000 日元（约合 2138.77 美元）/每获得一个 QALY。由于节省了成本，扎那米韦优于对照组。
虽然在我们的研究中，神经氨酸酶抑制剂在治疗健康成年人流感方面的成本效益（从医疗保健支付者的角度来看）优于对照组，但在推荐一种药物作为一线治疗药物之前，似乎有必要考虑其他因素。另一方面，我们建议扎那米韦是高危患者的首选药物，我们建议根据我们的结果，如果没有扎那米韦，应给予其他治疗而不是奥司他韦。由于流感感染会导致高危患者死亡和住院，这会对日本社会产生影响，因此，在决定适当的治疗方法时，应考虑到特定的患者群体。
