Management of influenza in adults older than 65 years of age: Cost-effectiveness of rapid testing and antiviral therapy
Management of influenza in adults older than 65 years of age: Cost-effectiveness of rapid testing and antiviral therapy
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DOI：
10.7326/0003-4819-139-5_part_1-200309020-00007
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发表时间：
2003-09-02
影响因子：
39.2
通讯作者：
Rose, DN
中科院分区：
文献类型：
--
作者：
Rothberg, MB;Bellantonio, S;Rose, DN
背景：虽然抗病毒治疗在成人中具有成本效益，但其在老年人中的成本效果尚未被研究。目的：确定流感检测和治疗策略在老年患者中的成本效果。设计：成本效用决策模型。数据来源：抗病毒药物的临床试验和流行病学数据。目标人群：65岁以上的非住院成年人患有流感样疾病。时间跨度：终生。视角：社会。干预：快速诊断检测或抗病毒药物的经验性治疗。结果：节省的每质量调整寿命年成本。基本病例分析结果：与不干预相比，经验性治疗未接种金刚烷胺的75岁患者的预期寿命增加了0.0014 QALY，成本-效果比为每节省1,129美元。与金刚烷胺相比，快速诊断检测和奥司他韦治疗每节省一QALY的成本为5025美元，而奥司他韦经验性治疗每节省的QALY成本为10296美元。如果患者接种了疫苗，测试和治疗策略的成本效益较低，从金刚烷胺每QALY节省2483美元到奥司他韦每QALY节省70300美元不等。敏感性分析结果：该决定对流感概率、奥司他韦预防住院的有效性以及住院和病死率敏感。该决定对药物副作用的概率或严重程度、流感疾病或住院的生活质量、抗病毒治疗在缩短流感疾病方面的有效性、或快速诊断试验特征不敏感。结论：对于流感季节未接种疫苗或高危接种的患者，经验性奥司他韦治疗是具有成本效益的。对于其他患者，快速诊断检测后再使用奥司他韦治疗是划算的。如果患者负担不起奥司他韦，经验性金刚烷胺治疗提供了一种低成本的替代方案。
Background: Although antiviral therapy is cost-effective in adults, its cost-effectiveness in older adults has not been studied.Objective: To determine the cost-effectiveness of influenza testing and treatment strategies for older adults.Design: Cost-utility decision model.Data Sources: Clinical trials of antiviral drugs and epidemiologic data.Target Population: Noninstitutionalized adults older than 65 years of age with influenza-like illness.Time Horizon: Lifetime. Perspective: Societal.Interventions: Rapid diagnostic testing or empirical therapy with antiviral drugs.Outcome Measures: Cost per quality-adjusted life-year (QALY) saved.Results of Base-Case Analysis: Compared with no intervention, empirically treating an unvaccinated 75-year-old patient with amantadine increased life expectancy by 0.0014 QALY at a cost of $1.57, a cost-effectiveness ratio of $1129 per QALY saved. Compared with amantadine, rapid diagnostic testing followed by treatment with oseltamivir cost $5025 per QALY saved and empirical treatment with oseltamivir cost $10 296 per QALY saved. Testing and treatment strategies were less cost-effective if the patient was vaccinated, ranging from $2483 per QALY saved with amantadine to $70 300 per QALY saved with oseltamivir.Results of Sensitivity Analysis: The decision was sensitive to the probability of influenza, the efficacy of oseltamivir in preventing hospitalizations, and hospitalization and case-fatality rates. The decision was not sensitive to the probability or severity of medication side effects, the quality of life for influenza illness or hospitalization, the efficacy of antiviral therapy in shortening influenza illness, or the rapid diagnostic test characteristics.Conclusions: For unvaccinated or high-risk vaccinated patients during the influenza season, empirical oseltamivir treatment is cost-effective. For other patients, rapid diagnostic testing followed by treatment with oseltamivir is cost-effective. Empirical amantadine treatment offers a low-cost alternative if patients cannot afford oseltamivir.