PURPOSE OF THE STUDY.
To evaluate the cost-effectiveness of oseltamivir treatment for seasonal influenza in children and consider the impact of oseltamivir resistance on these findings.
Unvaccinated children, stratified according to age groups (12–23 months, 2 years, 3–4 years, 5–11 years, and 12–17 years) visiting a physician’s office with age-appropriate symptoms of uncomplicated influenza-like illness.
The investigators developed a model to evaluate 1-year clinical and economic outcomes associated with 3 outpatient management strategies for unvaccinated children with influenza-like illness: no antiviral treatment; diagnostic testing and oseltamivir treatment when results were positive; and empiric oseltamivir treatment. The model depicted a hypothetical nonpandemic influenza season with a 29% level of oseltamivir resistance in circulating viruses and 14% to 54% probability of seasonal influenza with influenza-like illness. Strategies were compared by using incremental cost-effectiveness ratios.
In the preliminary analysis, empiric oseltamivir treatment consistently produced the greatest benefit. The incremental cost-effectiveness of this alternative, compared with testing and treating, was <$100,000 per quality-adjusted life-year gained in all age groups except the oldest. The testing strategy was consistently more effective compared with no treatment, and it costs between $25 900 and $71 200 per quality-adjusted life-year gained, depending on age. Results were sensitive to the prevalence of oseltamivir resistance in circulating viruses.
Empiric oseltamivir treatment of seasonal influenza is associated with favorable cost-effectiveness ratios, particularly in children aged 1 to <12 years. However, ratios are highly dependent on the prevalence of oseltamivir resistance among circulating influenza viruses.
What a breath of fresh air to find this very interesting and clinically relevant article that examined a cost-effective analysis which deals with how to best manage children presenting for medical attention with influenza-like illness. Despite the availability of rapid diagnostic testing, which is not always the most sensitive or specific, relying on clinical diagnosis and being aware of the level of oseltamivir resistance of circulating influenza viruses seems to be the ideal approach here. What a novel concept: relying on one’s clinical diagnostic skills to deal with these types of patients.
- Copyright © 2012 by the American Academy of Pediatrics