Interdisciplinary pharmacometrics linking oseltamivir pharmacology, influenza epidemiology and health economics to inform antiviral use in pandemics
| Autor: | Georgina Dall, Richard E. Nelson, David Bin-Chia Wu, Mohamed A. Kamal, Carl M. J. Kirkpatrick, Aaron W. C. Kamauu, Craig R Rayner, Kenneth K.C. Lee, Nathorn Chaiyakunapruk, Stephen Toovey, Chayanin Pratoomsoot, Keith Nieforth, David C. M. Kong, Huey Yi Chong, Patrick F. Smith |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Pharmacology medicine.medical_specialty Oseltamivir education.field_of_study Health economics business.industry 030106 microbiology Population Pharmacometrics 03 medical and health sciences Regimen chemistry.chemical_compound 0302 clinical medicine chemistry Epidemiology Pandemic medicine Pharmacology (medical) 030212 general & internal medicine Intensive care medicine business education Basic reproduction number |
| Zdroj: | British Journal of Clinical Pharmacology. 83:1580-1594 |
| ISSN: | 0306-5251 |
| DOI: | 10.1111/bcp.13229 |
| Popis: | Aims A modular interdisciplinary platform was developed to investigate the economic impact of oseltamivir treatment by dosage regimen under simulated influenza pandemic scenarios. Methods The pharmacology module consisted of a pharmacokinetic distribution of oseltamivir carboxylate daily area under the concentration–time curve at steady state (simulated for 75 mg and 150 mg twice daily regimens for 5 days) and a pharmacodynamic distribution of viral shedding duration obtained from phase II influenza inoculation data. The epidemiological module comprised a susceptible, exposed, infected, recovered (SEIR) model to which drug effect on the basic reproductive number (R0), a measure of transmissibility, was linked by reduction of viral shedding duration. The number of infected patients per population of 100 000 susceptible individuals was simulated for a series of pandemic scenarios, varying oseltamivir dose, R0 (1.9 vs. 2.7), and drug uptake (25%, 50%, and 80%). The number of infected patients for each scenario was entered into the health economics module, a decision analytic model populated with branch probabilities, disease utility, costs of hospitalized patients developing complications, and case-fatality rates. Change in quality-adjusted life years was determined relative to base case. Results Oseltamivir 75 mg relative to no treatment reduced the median number of infected patients, increased change in quality-adjusted life years by deaths averted, and was cost-saving under all scenarios; 150 mg relative to 75 mg was not cost effective in low transmissibility scenarios but was cost saving in high transmissibility scenarios. Conclusion This methodological study demonstrates proof of concept that the disciplines of pharmacology, disease epidemiology and health economics can be linked in a single quantitative framework. |
| Databáze: | OpenAIRE |
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