Impact of oseltamivir on the incidence of secondary complications of influenza in adolescent and adult patients: results from a retrospective population-based study
Impact of oseltamivir on the incidence of secondary complications of influenza in adolescent and adult patients: results from a retrospective population-based study
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DOI：
10.1185/030079907x242520
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发表时间：
2007-12-01
影响因子：
2.3
通讯作者：
Schulman, Kathy L.
中科院分区：
文献类型：
--
作者：
Blumentals, William A.;Schulman, Kathy L.
目的：评估奥司他韦在降低 13 岁以上健康青少年和成人患者中流感相关继发并发症风险方面的有效性。 研究设计和方法：利用美国 2000 年至 2006 年间六个流感季节（10 月至 3 月）的健康保险索赔数据（Thomson MarketScan 研究数据库）进行回顾性队列分析，以确定患有流感的成人和青少年（>= 13 岁）。将诊断后 +/- 1 天内接受奥司他韦处方的患者与未接受抗病毒治疗的倾向匹配对照组进行比较。第一个流感索赔证据被用来确定研究索引日期。使用 Cox 比例风险回归确定结果差异，并以风险比 (HR) 和 95% 置信区间 (CI) 表示。主要结果指标：肺炎诊断、任何呼吸系统疾病、中耳炎及其并发症、因肺炎住院以及指数日期后 14 天内因任何原因住院。还分析了索引日期后 30 天内的医疗支出。 结果：奥司他韦组和未经治疗的对照组各包括 36751 名符合条件的患者。使用奥司他韦可将中耳炎及其并发症的风险降低 23%（HR=0.77；95% CI：0.65，0.93），将任何呼吸道疾病的风险降低 18%（HR 0.82；95% CI：0.79，0.86），将因任何原因住院的风险降低 22%（HR 0.78；95% CI：0.67， 0.91）。任何其他临床结果没有差异，包括因呼吸道疾病住院。两组之间的医疗支出没有差异。局限性：该研究的回顾性意味着研究结果可能容易丢失或丢失数据。这里获得的结果代表参加私人医疗保健计划的个人，因此可能不能代表整个美国人口。缺乏流感病毒学诊断，以及基于首次诊断流感而不是首次接触或症状发作的索引日期可能导致对治疗效果的保守估计。结论：接受奥司他韦治疗的患者中，流感继发并发症（例如呼吸道疾病和中耳炎）减少。尽管因任何原因住院的风险有所降低，但因呼吸系统疾病住院的风险并未降低。奥司他韦观察到的临床获益与医疗费用的变化无关。
Objective: To assess the effectiveness of oseltamivir in reducing the risks of influenza-related secondary complications in otherwise healthy adolescent and adult patients aged >= 13 years.Research design and methods: Retrospective cohort analysis utilizing health insurance claims data in the USA (Thomson MarketScan Research Database) from six influenza seasons (October-March) between 2000 and 2006 to identify adults and adolescents (>= 13 years) with influenza. Patients who received a prescription for oseltamivir within +/- 1 day of diagnosis were compared with a propensity-matched control group receiving no antiviral treatment. The first claim evidence of influenza was used to establish the study index date. Differences in outcomes were determined using Cox proportional hazards regression and expressed in terms of hazard ratios (HR) with 95% confidence intervals (CI).Main outcome measures., Diagnosis of pneumonia, any respiratory condition, otitis media and its complications, hospitalizations due to pneumonia, and hospitalization for any reason within 14 days of the index date. Healthcare expenditure within 30 days of the index date was also analyzed.Results: The oseltamivir and untreated control groups each included 36751 eligible patients. Oseltamivir use reduced the risks of otitis media and its complications by 23% (HR=0.77; 95% CI: 0.65, 0.93), any respiratory disease by 18% (HR 0.82; 95% CI: 0.79, 0.86), and hospitalization for any reason by 22% (HR 0.78; 95% CI: 0.67, 0.91). There were no differences in any other clinical outcomes, including hospitalization for respiratory disease. Healthcare expenditure did not differ between the two groups. Limitations:The retrospective nature of the study meant that the findings may be susceptible to missing or lost data. The results obtained here represent individuals enrolled in private healthcare plans and may not, therefore, be representative of the entire US population. The lack of a virologic diagnosis of influenza, and an index date based on the first diagnosis of influenza rather than first exposure or symptom onset, may have resulted in a conservative estimate of treatment effect.Conclusions: Secondary complications of influenza, such as respiratory disease and otitis media, were reduced in patients treated with oseltamivir. The risk of hospitalization for respiratory diseases was not reduced, although there was a reduction in the risk of hospitalization for any reason. Clinical benefits observed with oseltamivir were not associated with a change in healthcare costs.