Public Health Computational and Operations Research, University of Pittsburgh School of Medicine and Graduate School of Public Health, PA 15213, USA.
Am J Manag Care. 2011 Jan;17(1):e1-9.
To develop 3 computer simulation models to determine the potential economic effect of using intravenous (IV) antiviral agents to treat hospitalized patients with influenza-like illness, as well as different testing and treatment strategies.
Stochastic decision analytic computer simulation model.
During the 2009 influenza A(H1N1) pandemic, the Food and Drug Administration granted emergency use authorization of IV neuraminidase inhibitors for hospitalized patients with influenza, creating a need for rapid decision analyses to help guide use. We compared the economic value from the societal and third-party payer perspectives of the following 4 strategies for a patient hospitalized with influenza-like illness and unable to take oral antiviral agents: Strategy 1: Administration of IV antiviral agents without polymerase chain reaction influenza testing. Strategy 2: Initiation of IV antiviral treatment, followed by polymerase chain reaction testing to determine whether the treatment should be continued. Strategy 3: Performance of polymerase chain reaction testing, followed by initiation of IV antiviral treatment if the test results are positive. Strategy 4: Administration of no IV antiviral agents. Sensitivity analyses varied the probability of having influenza (baseline, 10%; range, 10%-30%), IV antiviral efficacy (baseline, oral oseltamivir phosphate; range, 25%-75%), IV antiviral daily cost (range, $20-$1000), IV antiviral reduction of illness duration (baseline, 1 day; range, 1-2 days), and ventilated vs nonventilated status of the patient.
When the cost of IV antiviral agents was no more than $500 per day, the incremental cost-effectiveness ratio for most of the IV antiviral treatment strategies was less than $10,000 per quality-adjusted life-year compared with no treatment. When the cost was no more than $100 per day, all 3 IV antiviral strategies were even more cost-effective. The order of cost-effectiveness from most to least was strategies 3, 1, and 2. The findings were robust to changing risk of influenza, influenza mortality, IV antiviral efficacy, IV antiviral daily cost, IV antiviral reduction of illness duration, and ventilated vs nonventilated status of the patient for both societal and third-party payer perspectives.
Our study supports the use of IV antiviral treatment for hospitalized patients with influenza-like illness.
开发 3 个计算机模拟模型，以确定使用静脉内（IV）抗病毒药物治疗流感样疾病住院患者的潜在经济影响，以及不同的检测和治疗策略。
随机决策分析计算机模拟模型。
在 2009 年甲型 H1N1 流感大流行期间，食品和药物管理局授予静脉内神经氨酸酶抑制剂治疗流感住院患者的紧急使用授权，这就需要快速进行决策分析以帮助指导使用。我们比较了以下 4 种策略从社会和第三方支付者角度对流感样疾病住院且无法口服抗病毒药物的患者的经济价值：策略 1：在不进行聚合酶链反应（PCR）流感检测的情况下使用 IV 抗病毒药物。策略 2：开始 IV 抗病毒治疗，然后进行 PCR 检测以确定是否应继续治疗。策略 3：进行 PCR 检测，然后在检测结果阳性时开始 IV 抗病毒治疗。策略 4：不使用 IV 抗病毒药物。敏感性分析改变了流感的可能性（基线，10%；范围，10%-30%）、IV 抗病毒药物的疗效（基线，口服奥司他韦磷酸；范围，25%-75%）、IV 抗病毒药物的日费用（范围，$20-$1000）、IV 抗病毒药物缩短疾病持续时间（基线，1 天；范围，1-2 天）以及患者的通气与非通气状态。
当 IV 抗病毒药物的成本不超过每天$500 时，与不治疗相比，大多数 IV 抗病毒治疗策略的增量成本效益比低于每质量调整生命年$10000。当成本不超过每天$100 时，所有 3 种 IV 抗病毒策略都更加具有成本效益。从最到最不具有成本效益的顺序是策略 3、1 和 2。研究结果从社会和第三方支付者的角度来看，在改变流感风险、流感死亡率、IV 抗病毒疗效、IV 抗病毒日费用、IV 抗病毒缩短疾病持续时间以及患者通气与非通气状态时均具有稳健性。
我们的研究支持对流感样疾病住院患者使用 IV 抗病毒治疗。
