Research Triangle Institute (RTI), Health Solutions, Research Triangle Park, NC 27709, USA.
Am J Prev Med. 2009 Nov;37(5):381-8. doi: 10.1016/j.amepre.2009.08.012.
Postexposure prophylaxis (PEP) with oseltamivir (Tamiflu) has been shown to be effective and is approved in children exposed to a case of influenza in a household setting. Given limited healthcare budgets, it is important to understand the costs and cost effectiveness of PEP in children.
This study aims to estimate the cost effectiveness of oseltamivir PEP for children aged 1-12 years in the U.S.
A decision-tree model with a 1-year time horizon was used to assess the cost effectiveness of oseltamivir PEP for 10 days at approved doses compared with no prophylaxis for children aged 1-12 years who were exposed to a household index case of influenza from the U.S. societal and payer perspectives. Model inputs included U.S. influenza epidemiology data, efficacy data from oseltamivir PEP clinical trials, direct medical resource use and costs for PEP and influenza treatment derived from large U.S. databases, and indirect costs based on caregiver lost productivity. Base-case estimates were tested in extensive sensitivity analyses.
For the societal perspective, the model estimated 12,184 fewer cases of influenza per 100,000 children exposed and an incremental cost-effectiveness ratio of $41,452 per quality-adjusted life-year (QALY) gained. Results were most sensitive to the influenza attack rate, PEP protective efficacy, and prescribing patterns for initiating PEP. Probabilistic sensitivity analyses showed that oseltamivir PEP was likely to be cost effective for all willingness-to-pay threshold values above $34,300 per QALY gained. Results were similar for the payer perspective.
Although there is no official cost-effectiveness threshold in the U.S., results from the current study show that when compared with no prophylaxis, oseltamivir PEP for children has cost-effectiveness ratios similar to those of vaccines for preventing influenza.
奥司他韦（达菲）暴露后预防（PEP）已被证明有效，且已批准用于在家庭环境中接触流感病例的儿童。鉴于有限的医疗保健预算，了解儿童 PEP 的成本效益非常重要。
本研究旨在评估美国 1-12 岁儿童使用奥司他韦 PEP 的成本效益。
采用 1 年时间范围的决策树模型，从美国社会和支付者的角度评估了在家庭索引病例中接触流感的 1-12 岁儿童接受奥司他韦 PEP 10 天与不进行预防的成本效益。模型输入包括美国流感流行病学数据、奥司他韦 PEP 临床试验的疗效数据、源自大型美国数据库的 PEP 和流感治疗的直接医疗资源使用和成本以及基于照顾者丧失生产力的间接成本。基础案例估计在广泛的敏感性分析中进行了测试。
从社会角度来看，该模型估计每 10 万名暴露儿童中会减少 12184 例流感病例，增量成本效益比为每获得 1 个质量调整生命年（QALY）增加 41452 美元。结果对流感发病率、PEP 保护效力和开始 PEP 的处方模式最为敏感。概率敏感性分析表明，对于所有高于每获得 1 个 QALY 增加 34300 美元的意愿支付阈值，奥司他韦 PEP 很可能具有成本效益。支付者角度的结果相似。
尽管美国没有官方的成本效益阈值，但当前研究的结果表明，与不进行预防相比，奥司他韦 PEP 对儿童的成本效益比类似于预防流感的疫苗。
