Cost-utility analysis of antiviral use under pandemic influenza using a novel approach – linking pharmacology, epidemiology and heath economics
| Autor: | Mohamed A. Kamal, David C. M. Kong, Craig R Rayner, Nathorn Chaiyakunapruk, Georgina Dall, David Bin-Chia Wu, Chayanin Pratoomsoot, Stephen Toovey, Aaron Kamauu, Huey Yi Chong, Richard E. Nelson, Kenneth K.C. Lee, Patrick F. Smith, Carl M. J. Kirkpatrick, Keith Nieforth |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Oseltamivir Adolescent Epidemiology Cost-Benefit Analysis Pharmacology Antiviral Agents Drug Costs 03 medical and health sciences chemistry.chemical_compound Indirect costs 0302 clinical medicine Pandemic Influenza Human Medicine Humans 030212 general & internal medicine Child Pandemics Aged Cost–utility analysis Health economics Cost–benefit analysis business.industry 030503 health policy & services Infant Cost-effectiveness analysis Middle Aged Models Theoretical Original Papers Quality-adjusted life year Infectious Diseases Models Economic chemistry Child Preschool Female Quality-Adjusted Life Years 0305 other medical science business |
| Zdroj: | Epidemiol Infect |
| Popis: | Simulation models are used widely in pharmacology, epidemiology and health economics (HEs). However, there have been no attempts to incorporate models from these disciplines into a single integrated model. Accordingly, we explored this linkage to evaluate the epidemiological and economic impact of oseltamivir dose optimisation in supporting pandemic influenza planning in the USA. An HE decision analytic model was linked to a pharmacokinetic/pharmacodynamics (PK/PD) – dynamic transmission model simulating the impact of pandemic influenza with low virulence and low transmissibility and, high virulence and high transmissibility. The cost-utility analysis was from the payer and societal perspectives, comparing oseltamivir 75 and 150 mg twice daily (BID) to no treatment over a 1-year time horizon. Model parameters were derived from published studies. Outcomes were measured as cost per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to examine the integrated model's robustness. Under both pandemic scenarios, compared to no treatment, the use of oseltamivir 75 or 150 mg BID led to a significant reduction of influenza episodes and influenza-related deaths, translating to substantial savings of QALYs. Overall drug costs were offset by the reduction of both direct and indirect costs, making these two interventions cost-saving from both perspectives. The results were sensitive to the proportion of inpatient presentation at the emergency visit and patients’ quality of life. Integrating PK/PD–EPI/HE models is achievable. Whilst further refinement of this novel linkage model to more closely mimic the reality is needed, the current study has generated useful insights to support influenza pandemic planning. |
| Databáze: | OpenAIRE |
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