School of Pharmaceutical Sciences, Ohu University, Koriyama, Fukushima, Japan.
Pharma Brie, Sendai, Miyagi, Japan.
Value Health Reg Issues. 2021 May;24:117-122. doi: 10.1016/j.vhri.2020.07.579. Epub 2021 Feb 5.
Pharmacoeconomic studies have been less performed in Japan. The objective of this study was to clarify which neuraminidase inhibitor (NI; oseltamivir, zanamivir, laninamivir, and peramivir) is most cost-effective in an adult outpatient setting in Japan.
To clarify which neuraminidase inhibitor (NI; oseltamivir, zanamivir, laninamivir, and peramivir) is most cost-effective in an adult outpatient setting in Japan.
Cost-effectiveness analysis was constructed from the healthcare payer's perspective. A decision tree model was constructed with probabilities from relevant randomized controlled trials. Costs included medical costs and drug prices. Medical costs were obtained from the medical fee schedule table (2016 version). We also applied authorized medication costs. Outcomes of effectiveness were measured using EQ-5D-3L questionnaires for adult patients who had experienced influenza virus infections previously. Time horizon was 14 days in this study.
Cost-effectiveness ratios for oseltamivir, zanamivir, laninamivir, and peramivir were 393 674 Yen/quality-adjusted life year (QALY; US$3883.41/QALY), 408 241 (US$4027.10), 407 980 (US$4024.53), and 444 264 (US$4382.45), respectively. The cost-effectiveness analysis base-case analysis revealed oseltamivir as the most cost-effective NI. Zanamivir was dominated. Incremental cost effectiveness ratio (ICER) for laninamivir and peramivir were 1 129 459 Yen/QALY (US$11 141.58/QALY) and 1 287 118 (US$12 696.81), respectively. One-way sensitivity analyses revealed that minimum ICERs for laninamivir based on "quality of life (QOL) values (95% confidence interval)" was -596 850 Yen/QALY (US-$5887.64/QALY) owing to high cost and less effective. Also, maximum ICER for peramivir based on"QOL values" was 14 717 518 Yen/QALY (US$145 181.32/QALY); a value more than the 5 000 000 Yen/QALY threshold.
The study results reveal oseltamivir as the most cost-effective NI for the treatment of influenza virus infection in an adult outpatient setting. Our findings may provide decision makers with scientific evidence for clinical and economic evaluation to achieve optimal therapeutic outcomes.
在日本，药物经济学研究的开展相对较少。本研究的目的是明确在日本成人门诊环境中，哪种神经氨酸酶抑制剂（NI；奥司他韦、扎那米韦、拉尼米韦和帕拉米韦）具有最高的成本效益。
明确在日本成人门诊环境中，哪种神经氨酸酶抑制剂（NI；奥司他韦、扎那米韦、拉尼米韦和帕拉米韦）具有最高的成本效益。
从医疗保健支付者的角度进行成本效益分析。使用来自相关随机对照试验的概率构建决策树模型。成本包括医疗费用和药物价格。医疗费用取自医疗费用表（2016 年版）。我们还应用了授权药物的费用。对先前经历过流感病毒感染的成年患者使用 EQ-5D-3L 问卷来衡量有效性结果。本研究的时间范围为 14 天。
奥司他韦、扎那米韦、拉尼米韦和帕拉米韦的成本效益比分别为 393674 日元/质量调整生命年（QALY；3883.41 美元/QALY）、408241 日元（4027.10 美元）、407980 日元（4024.53 美元）和 444264 日元（4382.45 美元）。基于奥司他韦的成本效益分析基本情况表明，奥司他韦是最具成本效益的 NI。扎那米韦被认为是主导方案。拉尼米韦和帕拉米韦的增量成本效益比（ICER）分别为 1129459 日元/QALY（11141.58 美元/QALY）和 1287118 日元（12696.81 美元）。单因素敏感性分析显示，拉尼米韦的最低 ICER 基于“生活质量（QOL）值（95%置信区间）”为-596850 日元/QALY（-5887.64 美元/QALY），原因是成本高且疗效较低。此外，基于“QOL 值”，帕拉米韦的最高 ICER 为 14717518 日元/QALY（145181.32 美元/QALY）；这一数值超过了 5000000 日元/QALY 的阈值。
研究结果表明，奥司他韦是治疗成人门诊流感病毒感染最具成本效益的 NI。我们的研究结果可能为决策者提供临床和经济评估的科学证据，以实现最佳治疗效果。
