Cost-effectiveness of newer treatment strategies for influenza
Cost-effectiveness of newer treatment strategies for influenza
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DOI：
10.1016/s0002-9343(02)01222-6
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发表时间：
2002-09-01
影响因子：
5.9
通讯作者：
Roberts, MS
中科院分区：
文献类型：
--
作者：
Smith, KJ;Roberts, MS
目的：流感诊断和治疗方面的最新进展，例如快速检测和神经氨酸酶抑制剂治疗，但它们在临床实践中的地位和成本效益尚未确定。材料和方法：为了估计这些新干预措施的成本效益，我们使用了一个决策模型，比较了几种流感管理策略：不进行检测或治疗，不进行检测或金刚烷胺或金刚乙胺治疗，不进行检测，然后进行金刚烷胺或金刚乙胺治疗，未经测试的神经氨酸酶抑制剂治疗，或测试后再进行神经氨酸酶抑制剂治疗。具有流感特征症状的发热患者在 48 小时内开始抗病毒治疗。我们假设抗病毒治疗不会改变流感并发症或死亡率，并在基线分析中选择参数值，以稍微偏向抗病毒治疗和检测策略。结果：在基线分析中，检测策略比治疗策略更昂贵且效果较差。金刚烷胺每避免患病一天的费用为 9.06 美元，或每增加质量调整日的费用为 11.60 美元。与金刚烷胺相比，扎那米韦每避免一个病日的费用为 198 美元，或每增加一个质量调整日的费用为 185 美元，而奥司他韦每避免一个病日的费用为 252 美元，或每增加一个质量调整日的费用为 235 美元。在需要减少剂量的老年患者中，与金刚烷胺相比，金刚乙胺每质量调整日的费用为 128 美元。在年轻患者中，如果甲型流感的可能性 > 67%，金刚烷胺更受青睐；否则，神经氨酸酶抑制剂更受青睐。当流感概率 > 30 时，检测策略成本更高且效果较差。如果流感概率为 0.77，则不支持任何检测或治疗。对于老年患者，如果药物副作用效用>0.94，则金刚烷胺优于金刚乙胺。 结论：对于流感季节有典型症状的发热患者，无需快速检测的流感抗病毒治疗在经济上是合理的。抗病毒药物的选择取决于年龄、甲型流感的可能性以及按质量调整后的天数支付的意愿。
PURPOSE: Recent advances in the diagnosis and treatment of influenza, such as rapid testing and neuraminidase inhibitor therapy, are available, but their place in clinical practice and their cost-effectiveness have not been determined.MATERIALS AND METHODS: To estimate the cost-effectiveness of these newer interventions, we used a decision model that compared several influenza management strategies: no testing or treatment, amantadine or rimantadine treatment without testing, testing then amantadine or rimantadine treatment, neuraminidase inhibitor treatment without testing, or testing then neuraminidase inhibitor treatment. Antiviral therapy began within 48 hours in febrile patients with characteristic symptoms of influenza. We assumed that antiviral treatment did not change rates of influenza complication or mortality, and chose parameter values in the baseline analysis to bias slightly against antiviral treatment and toward testing strategies.RESULTS: In the baseline analysis, testing strategies are more expensive and less effective than treatment strategies. Amantadine costs $9.06 per illness day avoided or $11.60 per quality-adjusted day gained. Compared with amantadine, zanamivir costs $198 per illness day avoided or $185 per quality-adjusted day gained, whereas oseltamivir costs $252 per illness day avoided or $235 per quality-adjusted day gained. In elderly patients who require reduced dosage, rimantadine costs $128 per quality-adjusted day gained compared with amantadine, In younger patients, amantadine is favored if the likelihood of influenza A is >67%; otherwise, neuraminidase inhibitors are favored. Testing strategies are more costly and less effective when the influenza probability is >30. No testing or treatment is favored if the influenza probability is 0.77. In elderly patients, amantadine is favored over rimantadine if the utility of medication side effects is >0.94.CONCLUSION: Antiviral treatment of influenza without rapid testing is reasonable economically in febrile patients with typical symptoms during influenza season. The choice of antiviral agent depends on age, the likelihood of influenza A, and the willingness to pay per quality-adjusted day gained.