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Testing for and Treating Influenza in Elders Can Be Cost-Effective

In vaccinated elders, test-and-treat worked best. In unvaccinated elders, empirical oseltamivir was effective.

The newer influenza drugs zanamivir and oseltamivir (neuraminidase inhibitors) effectively reduce symptom duration, limit bacterial complications, and have few side effects. However, these drugs are costly and are effective only when started within 48 hours after symptom onset.

In a cost-utility analysis, researchers compared 9 influenza testing and treatment strategies: no antiviral therapy; empirical treatment with oseltamivir, zanamivir, amantadine, or rimantadine; and rapid testing followed treatment with 1 of the 4 drugs if test results were positive. The analysis initially assumed a healthy, unvaccinated 75-year-old who presented to a primary care practice during influenza season with an influenza-like illness. Additional analyses varied these and other assumptions (e.g., vaccination status, season).

In an unvaccinated person, the most effective strategy (most quality-adjusted life-years [QALYs] saved) was empirical oseltamivir; this strategy also was cost-effective at US$10,296 per QALY saved (compared with testing followed by oseltamivir). Other less effective -- but also less costly -- strategies were empirical amantadine (US$1129 per QALY saved, compared with no antiviral therapy) and testing followed by oseltamivir (US$5025 per QALY saved, compared with empirical amantadine).

In a vaccinated 75-year-old, testing and then treating with oseltamivir was the most cost-effective strategy. Drug therapy was not cost-effective when risk for hospitalization and probability of influenza were low (i.e., in a patient with no medical comorbidity, at a time when influenza is not prevalent).

Comment: The authors point out an assumption that could invalidate their conclusions: Limited evidence has been collected regarding the effectiveness of anti-influenza drugs in older adults. However, if such drugs are as effective in elders as in younger adults (a big "if"), empirical treatment with oseltamivir during flu season would be worthwhile, despite the high cost of the drug itself.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine October 3, 2003

Citation(s):

Rothberg MB et al. Management of influenza in adults older than 65 years of age: Cost-effectiveness of rapid testing and antiviral therapy. Ann Intern Med 2003 Sep 2; 139:321-9.

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