Talbird Sandra E, Brogan Anita J, Winiarski Aleksander P, Sander Beate
RTI Health Solutions, Research Triangle Park, NC 27709-2194, USA.
Am J Health Syst Pharm. 2009 Mar 1;66(5):469-80. doi: 10.2146/ajhp080296.
The cost-effectiveness of treating influenzalike illness (ILI) with oseltamivir in the United States was assessed.
A decision-analysis model was developed with a one-year time horizon to assess the cost-effectiveness of oseltamivir compared with usual care from societal and payer perspectives for four patient populations: high-risk adults, healthy adults, elderly adults, and children. The model used efficacy data from oseltamivir clinical trials and other published literature and assumed oseltamivir was effective only in individuals infected with influenza virus not resistant to oseltamivir and treated within 48 hours of symptom onset. Direct medical costs were based on resources used; indirect costs were estimated based on time lost from work due to illness and premature mortality. Base-case estimates were tested in one-way sensitivity and variability analyses.
From a societal perspective, oseltamivir was cost-effective across all populations modeled, with an incremental cost per quality-adjusted life-year gained of $5,388, $6,317, $7,652, and $16,176 for high-risk adults, children, elderly adults, and healthy adults, respectively. Results were similar from a payer perspective. When indirect costs were included (for all populations except elderly adults), oseltamivir was cost saving. In sensitivity analyses, oseltamivir remained cost-effective across all patient populations for all values tested, except the probability of developing influenza-related pneumonia. Variability analyses showed that oseltamivir remained cost-effective under most scenarios tested.
Base-case results and sensitivity analyses from a decision-analysis model found that treatment of ILI with oseltamivir was cost-effective compared with usual care from U.S. payer and societal perspectives in all patient populations studied when only direct costs were considered.
评估在美国使用奥司他韦治疗流感样疾病（ILI）的成本效益。
建立了一个为期一年的决策分析模型，从社会和支付方的角度评估奥司他韦与常规治疗相比对四类患者群体（高危成年人、健康成年人、老年人和儿童）的成本效益。该模型使用了奥司他韦临床试验和其他已发表文献中的疗效数据，并假设奥司他韦仅对感染对奥司他韦敏感的流感病毒且在症状出现后48小时内接受治疗的个体有效。直接医疗成本基于所使用的资源；间接成本根据因病误工和过早死亡导致的时间损失进行估算。在单向敏感性和变异性分析中对基础病例估计值进行了检验。
从社会角度来看，在所有建模人群中，奥司他韦均具有成本效益，高危成年人、儿童、老年人和健康成年人每获得一个质量调整生命年的增量成本分别为5388美元、6317美元、7652美元和16176美元。从支付方角度来看，结果类似。当纳入间接成本时（老年人除外的所有人群），奥司他韦具有成本节约效益。在敏感性分析中，除了发生与流感相关肺炎的概率外，对于所有测试值，奥司他韦在所有患者群体中均保持成本效益。变异性分析表明，在大多数测试场景下，奥司他韦仍具有成本效益。
决策分析模型的基础病例结果和敏感性分析发现，从美国支付方和社会角度来看，在仅考虑直接成本的情况下，使用奥司他韦治疗ILI与常规治疗相比，在所有研究的患者群体中均具有成本效益。
