Abstract
BackgroundSeasonal and 2009 H1N1 influenza viruses may cause severe diseases and result in excess hospitalization and mortality in the older and younger adults, respectively. Early antiviral treatment may improve clinical outcomes. We examined potential outcomes and costs of test-guided versus empirical treatment in patients hospitalized for suspected influenza in Hong Kong.MethodsWe designed a decision tree to simulate potential outcomes of four management strategies in adults hospitalized for severe respiratory infection suspected of influenza: “immunofluorescence-assay” (IFA) or “polymerase-chain-reaction” (PCR)-guided oseltamivir treatment, “empirical treatment plus PCR” and “empirical treatment alone”. Model inputs were derived from literature. The average prevalence (11%) of influenza in 2010–2011 (58% being 2009 H1N1) among cases of respiratory infections was used in the base-case analysis. Primary outcome simulated was cost per quality-adjusted life-year (QALY) expected (ICER) from the Hong Kong healthcare providers' perspective.ResultsIn base-case analysis, “empirical treatment alone” was shown to be the most cost-effective strategy and dominated the other three options. Sensitivity analyses showed that “PCR-guided treatment” would dominate “empirical treatment alone” when the daily cost of oseltamivir exceeded USD18, or when influenza prevalence was <2.5% and the predominant circulating viruses were not 2009 H1N1. Using USD50,000 as the threshold of willingness-to-pay, “empirical treatment alone” and “PCR-guided treatment” were cost-effective 97% and 3% of time, respectively, in 10,000 Monte-Carlo simulations.ConclusionsDuring influenza epidemics, empirical antiviral treatment appears to be a cost-effective strategy in managing patients hospitalized with severe respiratory infection suspected of influenza, from the perspective of healthcare providers in Hong Kong.
Highlights
Seasonal influenza results in excess hospitalization and mortality, with highest risk for young children, adults aged $65 years and patients with chronic medical conditions [1]
Model Design A decision tree was designed to simulate the outcomes of four clinical management strategies in a hypothetical cohort of adult patients hospitalized for severe respiratory infection, suspected of influenza, including: (1) using IFA, or (2) PCR testing to guide antiviral treatment; (3) empirical antiviral treatment plus PCR testing, and later decide to continue or discontinue treatment based on test results, and (4) empirical antiviral treatment alone (Figure 1)
Base-case analysis In the base-case analysis (Table 2), it was shown that the quality-adjusted life-year (QALY) expected from surviving influenza infection in the ‘‘empirical treatment alone’’ study arm was highest (1.6917 QALYs), and that it was the least costly option (USD 1,247)
Summary
Seasonal influenza results in excess hospitalization and mortality, with highest risk for young children, adults aged $65 years and patients with chronic medical conditions [1]. In 2009, a novel influenza A(H1N1) virus of swine origin had caused a pandemic [2,3]. The key epidemiological feature of this novel infection is that younger adults ,65 years are more commonly infected, and they too may develop severe and fatal diseases, even in the absence of underlying medical conditions [3]. Seasonal and 2009 H1N1 influenza viruses may cause severe diseases and result in excess hospitalization and mortality in the older and younger adults, respectively.
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