Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Public Health (Oxf). 2019 Jun 1;41(2):379-390. doi: 10.1093/pubmed/fdy108.
Many countries have acquired antiviral stockpiles for pandemic influenza mitigation and a significant part of the stockpile may be focussed towards community-based treatment.
We developed a spreadsheet-based, decision tree model to assess outcomes averted and cost-effectiveness of antiviral treatment for outpatient use from the perspective of the healthcare payer in the UK. We defined five pandemic scenarios-one based on the 2009 A(H1N1) pandemic and four hypothetical scenarios varying in measures of transmissibility and severity.
Community-based antiviral treatment was estimated to avert 14-23% of hospitalizations in an overall population of 62.28 million. Higher proportions of averted outcomes were seen in patients with high-risk conditions, when compared to non-high-risk patients. We found that antiviral treatment was cost-saving across pandemic scenarios for high-risk population groups, and cost-saving for the overall population in higher severity influenza pandemics. Antiviral effectiveness had the greatest influence on both the number of hospitalizations averted and on cost-effectiveness.
This analysis shows that across pandemic scenarios, antiviral treatment can be cost-saving for population groups at high risk of influenza-related complications.
许多国家都储备了抗病毒药物以应对大流行流感，并将其中很大一部分储备用于以社区为基础的治疗。
我们开发了一个基于电子表格的决策树模型，从英国医疗保健支付者的角度评估了抗病毒药物在门诊使用时的治疗效果和成本效益。我们定义了五种大流行情景——一种基于 2009 年 A（H1N1）大流行，另外四种是假设的情景，其传染性和严重程度的衡量标准不同。
在 6228 万总人口中，基于社区的抗病毒治疗估计可以避免 14-23%的住院治疗。与非高危患者相比，高危患者的治疗效果更好。我们发现，在高风险人群中，抗病毒治疗在所有大流行情景下都是节省成本的，在流感大流行严重程度较高的情况下，对整个人群也是节省成本的。抗病毒药物的有效性对避免住院人数和成本效益都有最大的影响。
这项分析表明，在所有大流行情景下，抗病毒治疗都可以为有流感相关并发症高风险的人群节省成本。
