From the Section of Decision Sciences and Clinical Systems Modeling, School of Medicine; Department of Biomedical Informatics, School of Medicine; Department of Epidemiology, Graduate School of Public Health; and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2009 Nov;114(5):971-980. doi: 10.1097/AOG.0b013e3181bdbfed.
To estimate the economic value of administering antiviral medications to pregnant women who have come in contact with an infectious individual with influenza.
A computer-simulation model was developed to predict the potential economic effect of antiviral use for postexposure prophylaxis among pregnant women in both seasonal influenza and pandemic influenza scenarios. The model allowed us to examine the effects of varying influenza exposure risk, antiviral efficacy, antiviral cost, and the probability of different influenza outcomes such as hospitalization, preterm delivery, and mortality.
For a variety of pandemic influenza scenarios (attack rate 20% or more, probability of preterm birth for women with influenza 12% or more, mortality for a preterm neonate 2% or more, and probability of influenza-attributable hospitalization 4.8% or more), the postexposure prophylactic use of antiviral medications was strongly cost-effective, with incremental cost-effectiveness ratio values below $50,000 per quality-adjusted life-year. Antiviral prophylaxis became an economically dominant strategy (that is, less costly and more effective) when the influenza attack rate is 20% or more and preterm birth rate is 36% or more, and when attack rate is 30% or more and preterm birth rate is 24% or more. Antiviral prophylaxis was not cost-effective under seasonal influenza conditions.
These findings support the use of antiviral medications for postexposure prophylaxis among pregnant women in a pandemic influenza scenario but not in a seasonal influenza setting.
评估对接触流感传染性个体的孕妇进行抗病毒药物治疗的经济价值。
开发了一种计算机模拟模型，以预测在季节性流感和大流行流感情况下对孕妇进行暴露后预防使用抗病毒药物的潜在经济影响。该模型使我们能够检查不同的流感暴露风险、抗病毒疗效、抗病毒药物成本以及不同流感结局（如住院、早产和死亡）的可能性的影响。
对于多种大流行流感情况（发病率为 20%或更高，流感孕妇的早产概率为 12%或更高，早产儿的死亡率为 2%或更高，以及与流感相关的住院率为 4.8%或更高），暴露后预防性使用抗病毒药物具有很强的成本效益，增量成本效益比低于每质量调整生命年 50000 美元。当流感发病率为 20%或更高，早产率为 36%或更高，或者当发病率为 30%或更高，早产率为 24%或更高时，抗病毒预防成为一种具有成本效益的策略（即成本更低、效果更好）。在季节性流感情况下，抗病毒预防并不具有成本效益。
这些发现支持在大流行流感情况下对孕妇使用抗病毒药物进行暴露后预防，但不支持在季节性流感情况下使用。
