Postma Maarten J, Novak Annoesjka, Scheijbeler Huib W K F H, Gyldmark Marlene, van Genugten Marianne L L, Wilschut Jan C
Graduate Schools SHARE and GUIDE, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, The Netherlands.
Pharmacoeconomics. 2007;25(6):497-509. doi: 10.2165/00019053-200725060-00005.
Oseltamivir is effective in the treatment of influenza. Utilisation in The Netherlands is limited, but increasing.
To estimate the cost effectiveness of oseltamivir treatment (vs symptom relief only) for patients with influenza-like illness (ILI) who are at increased risk for serious complications of influenza.
A cost-effectiveness analysis was used, building on a previously developed model (decision tree) that was applied for evaluating influenza vaccination and pandemic preparedness plans. Three patient subgroups were assessed (elderly patients [aged > or = 65 years] without chronic disease, elderly patients with chronic disease, and chronically ill, non-elderly patients). Inputs for the model were taken from various sources including a meta-analysis. A societal perspective was adopted and costs were expressed in euro per life-year gained (year 2003 values). Life-years lost were discounted at 4% in accordance with Dutch guidelines. Deterministic and probabilistic sensitivity analyses were employed to assess the robustness of the results.
For chronically ill patients with ILI, visits to the GP for oseltamivir treatment were cost saving. For non-chronically ill elderly patients, incremental cost-effectiveness was estimated at 1759 euros per life-year gained. Cost savings and favourable cost effectiveness were robust in a deterministic and stochastic sensitivity analysis.
Our model-based analysis suggests that at-risk people presenting with ILI to a GP could be offered oseltamivir at favourable cost effectiveness or even cost savings in the Dutch setting compared with symptom relief with analgesics only.
奥司他韦对流感治疗有效。在荷兰其使用有限，但呈上升趋势。
评估奥司他韦治疗（与仅缓解症状相比）对有流感严重并发症高风险的流感样疾病（ILI）患者的成本效益。
采用成本效益分析，基于先前开发的用于评估流感疫苗接种和大流行防范计划的模型（决策树）。评估了三个患者亚组（无慢性病的老年患者[年龄≥65岁]、有慢性病的老年患者以及慢性病非老年患者）。模型的输入数据来自包括荟萃分析在内的各种来源。采用社会视角，成本以每获得的生命年欧元数表示（2003年的值）。根据荷兰指南，生命年损失按4%进行贴现。采用确定性和概率敏感性分析来评估结果的稳健性。
对于患有ILI的慢性病患者，因奥司他韦治疗而看全科医生的费用有所节省。对于非慢性病老年患者，每获得一个生命年的增量成本效益估计为1759欧元。在确定性和随机敏感性分析中，成本节省和良好的成本效益是稳健的。
我们基于模型的分析表明，在荷兰，与仅用镇痛药缓解症状相比，向全科医生就诊的ILI高危人群使用奥司他韦可能具有良好的成本效益，甚至能节省费用。
