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Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries |
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| Authors: | Li Xiao Bilcke Joke van der Velden Alike W. Bruyndonckx Robin Coenen Samuel Bongard Emily de Paor Muirrean Chlabicz Slawomir Godycki-Cwirko Maciek Francis Nick Aabenhus Rune Bucher Heiner C. Colliers Annelies De Sutter An Garcia-Sangenis Ana Glinz Dominik Harbin Nicolay J. Kosiek Katarzyna Lindbæk Morten Lionis Christos Llor Carl Mikó-Pauer Réka Radzeviciene Jurgute Ruta Seifert Bohumil Sundvall Pär-Daniel Touboul Lundgren Pia Tsakountakis Nikolaos Verheij Theo J. Goossens Herman Butler Christopher C. Beutels Philippe |
| Affiliation: | 1.Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Campus Drie Eiken, room D.S.221, Universiteitsplein 1, 2610, Antwerp, Belgium ;2.Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands ;3.Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Data Science Institute (DSI), Hasselt University, Hasselt, Belgium ;4.Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium ;5.Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium ;6.The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK ;7.RCSI Department of General Practice, 123 St Stephens Green, Dublin 2, Ireland ;8.Department of Family Medicine, Medical University of Bialystok, Białystok, Poland ;9.Centre for Family and Community Medicine, Medical University of Lodz, Lodz, Poland ;10.School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK ;11.Section and Research Unit of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark ;12.Division of Infectious Diseases and Hospital Hygiene, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland ;13.Department of Public Health and Primary Care (Centre for Family Medicine), Gent University, Gent, Belgium ;14.University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain ;15.Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland ;16.Department of General Practice, Antibiotic Center for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway ;17.Family Doctors’ Clinic, Lodz, Poland ;18.Research Leader Antibiotic Centre for Primary Care, Department of General Practice, University of Oslo, Oslo, Norway ;19.General Practice and Primary Health Care at the School of Medicine, University of Crete, Crete, Greece ;20.Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark ;21.DRC Drug Research Center LLC, Balatonfüred, Hungary ;22.FDC Mano šeimos gydytojas, Klaipeda, Lithuania ;23.Institute of General Practice, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic ;24.General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ;25.Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Sandared, Sweden ;26.Département de Santé Publique, Hôpital de l’Archet, Nice, France ;27.Malia Surgery, Kastelli HC, Heraklio, Greece ; |
| Abstract: | Background Oseltamivir is usually not often prescribed (or reimbursed) for non-high-risk patients consulting for influenza-like-illness (ILI) in primary care in Europe. We aimed to evaluate the cost-effectiveness of adding oseltamivir to usual primary care in adults/adolescents (13 years +) and children with ILI during seasonal influenza epidemics, using data collected in an open-label, multi-season, randomised controlled trial of oseltamivir in 15 European countries. MethodsDirect and indirect cost estimates were based on patient reported resource use and official country-specific unit costs. Health-Related Quality of Life was assessed by EQ-5D questionnaires. Costs and quality adjusted life-years (QALY) were bootstrapped (N = 10,000) to estimate incremental cost-effectiveness ratios (ICER), from both the healthcare payers’ and the societal perspectives, with uncertainty expressed through probabilistic sensitivity analysis and expected value for perfect information (EVPI) analysis. Additionally, scenario (self-reported spending), comorbidities subgroup and country-specific analyses were performed. ResultsThe healthcare payers’ expected ICERs of oseltamivir were €22,459 per QALY gained in adults/adolescents and €13,001 in children. From the societal perspective, oseltamivir was cost-saving in adults/adolescents, but the ICER is €8,344 in children. Large uncertainties were observed in subgroups with comorbidities, especially for children. The expected ICERs and extent of decision uncertainty varied between countries (EVPI ranged €1–€35 per patient). ConclusionAdding oseltamivir to primary usual care in Europe is likely to be cost-effective for treating adults/adolescents and children with ILI from the healthcare payers’ perspective (if willingness-to-pay per QALY gained > €22,459) and cost-saving in adults/adolescents from a societal perspective. |
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