Antiviral treatment for outpatient use during an influenza pandemic: a decision tree model of outcomes averted and cost-effectiveness

Myles, Puja R; Venkatesan, Sudhir; Carias, Cristina; Biggerstaff, Matthew; Campbell, Angela P; Nguyen-Van-Tam, Jonathan S; Kahn, Emily; Myles, Puja R.; Meltzer, Martin I

Abstract

Background: Many countries have acquired antiviral stockpiles for pandemic influenza mitigation and a significant part of the stockpile may be focussed towards community-based treatment.

Methods: We developed a spreadsheet-based, decision tree model to assess outcomes averted and cost-effectiveness of antiviral treatment for outpatient use from the perspective of the healthcare payer in the UK. We defined five pandemic scenarios– one based on the 2009 A(H1N1) pandemic and four hypothetical scenarios varying in measures of transmissibility and severity.

Results: Community-based antiviral treatment was estimated to avert 14% to 23% of hospitalizations in an overall population of 62.28 million. Higher proportions of averted outcomes were seen in patients with high-risk conditions, when compared to non-high-risk patients. We found that antiviral treatment was cost-saving across pandemic scenarios for high-risk population groups, and cost-saving for the overall population in higher severity influenza pandemics. Antiviral effectiveness had the greatest influence on both the number of hospitalizations averted and on cost-effectiveness.

Conclusions: This analysis shows that across pandemic scenarios, antiviral treatment can be cost-saving for population groups at high risk of influenza-related complications.

Citation

Myles, P. R., Venkatesan, S., Carias, C., Biggerstaff, M., Campbell, A. P., Nguyen-Van-Tam, J. S., Kahn, E., Myles, P. R., & Meltzer, M. I. (2019). Antiviral treatment for outpatient use during an influenza pandemic: a decision tree model of outcomes averted and cost-effectiveness. Journal of Public Health, 41(2), 379–390. https://doi.org/10.1093/pubmed/fdy108

• Journal Article Type: Article
• Acceptance Date: Jun 8, 2018
• Online Publication Date: Jun 28, 2018
• Publication Date: 2019-06
• Deposit Date: Jun 19, 2018
• Publicly Available Date: Jun 29, 2019
• Journal: Journal of Public Health
• Print ISSN: 1741-3842
• Electronic ISSN: 1741-3850
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 41
• Issue: 2
• Pages: 379–390
• DOI: https://doi.org/10.1093/pubmed/fdy108
• Public URL: https://nottingham-repository.worktribe.com/output/942992
• Publisher URL: https://academic.oup.com/jpubhealth/article/41/2/379/5046089
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Public Health following peer review. The version of record Sudhir Venkatesan, Cristina Carias, Matthew Biggerstaff, Angela P Campbell, Jonathan S Nguyen-Van-Tam, Emily Kahn, Puja R Myles, Martin I Meltzer; Antiviral treatment for outpatient use during an influenza pandemic: a decision tree model of outcomes averted and cost-effectiveness, Journal of Public Health, fdy108 is available online at: https://doi.org/10.1093/pubmed/fdy108.
• Contract Date: Jun 19, 2018