Impact of Adding Oseltamivir to Usual Care on Quality-Adjusted Life-Years During Influenza-Like Illness
Bruyndonckx, Robin; Bilcke, Joke; van der Velden, Alike W; Li, Xiao; Hens, Niel; Coenen, Samuel; Butler, Christopher C; Beutels, Philippe
(2022) Value in Health, volume 25, issue 2, pp. 178 - 184
(Article)
Abstract
Objectives: The ALIC 4E trial has shown that oseltamivir reduces recovery time while increasing the risk of nausea. This secondary analysis of the ALIC 4E trial aimed to determine the gain in quality-adjusted life-years (QALYs) associated with adding oseltamivir to usual primary care in patients presenting with influenza-like illness (ILI).
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Methods: Patients with ILI were recruited during the influenza season (2015-2018) in 15 European countries. Patients were assigned to usual care with or without oseltamivir through stratified randomization (age, severity, comorbidities, and symptom onset). Patients’ health status was valued with the EQ-5D and visual analog scale (VAS) for up to 28 days. Average EQ-5D and VAS scores over time were estimated for both treatment groups using one-inflated beta regression in children (<13 years old) and adults (≥13 years old). QALY gain was calculated as the difference between the groups. Sensitivity analysis considered the value set to convert EQ-5D answers to summary scores and the follow-up period. Results: In adults, oseltamivir gained 0.0006 (95% confidence interval 0.0002-0.0010) QALYs, whereas no statistically significant gain was found in children (14-day follow-up, EQ-5D). QALY gains were statistically significant in patients aged ≥65 years, patients without relevant comorbidities, or patients experiencing symptoms for ≤48 hours. Using VAS and accounting for 28-day follow-up resulted in higher QALY gain. Conclusions: QALY gain owing to oseltamivir is limited compared with other diseases, and its clinical meaningfulness remains to be determined. Further analysis is needed to evaluate whether QALY gain and its impact on ILI treatment cost render oseltamivir cost-effective.
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Keywords: EQ-5D, Tamiflu, influenza, quality-adjusted life-years, visual analog scale, Health Policy, Public Health, Environmental and Occupational Health
ISSN: 1098-3015
Publisher: Elsevier Limited
Note: Funding Information: Conflict of Interest Disclosures: Drs Bruyndonckx and Bilcke reported receiving grants from Methusalem funding from the VAX-IDEA and ASCID Centers of Excellence in vaccination and infectious diseases at the University of Antwerp during the conduct of the study and a personal postdoctoral grant from Research Foundation – Flanders (FWO) during the conduct of the study. Dr Li reported receiving grants from Methusalem funding from the VAX-IDEA and ASCID Centers of Excellence in vaccination and infectious diseases at the University of Antwerp during the conduct of the study. Dr Coenen reported receiving grants from European Commission’s Seventh Framework (P7) Program during the conduct of this study. Dr Butler reported receiving grants for being a senior investigator for the National Institute for Health Research outside the submitted work; grants from the National Institute for Health Research Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance outside the submitted work; grants as the director of the National Institute for Health Research MedTech and In Vitro Diagnostics Cooperative for innovative diagnostic and monitoring technology to enhance Community Healthcare from Roche Molecular Diagnostics outside of the submitted work; personal fees from Roche Molecular Systems where he contributed to an advisory board meeting on February 4 and 5, 2016, about point-of-care testing outside the submitted work; holding an investigator-initiated grant from Roche Molecular Diagnostics to do an evaluation of the analytic performance of the Cobas Liat point-of-care device for detecting influenza using samples from a separately funded study from December 1, 2017, to May 31, 2019, from Roche Molecular Diagnostics outside of the submitted work; personal fees for attending an advisory board about the epidemiology of respiratory syntactical virus in Philadelphia on April 9, 2019, from Pfizer outside the submitted work; personal fees for being on the 2020 Advisory Board of Roche Diagnostics outside the submitted work; and personal fees for being on the 2020 Advisory Board of Janssen Pharmaceuticals outside the submitted work. Dr Beutels reported receiving grants from the European Commission’s Seventh Framework Program (HEALTH-F3-2013-602525) outside the submitted work, grants from Methusalem funding from the VAX-IDEA and ASCID Centers of Excellence in vaccination and infectious diseases at the University of Antwerp during the conduct of the study, and grants from the European commission IMI project RESCEU outside of the submitted work. No other disclosures were reported. Funding Information: Funding/Support: This work and ALIC4E trial was supported by the European Commission's Seventh Framework Programme: Platform for European Preparedness Against (Re-)emerging Epidemics (grant HEALTH-F3-2013-602525). Publisher Copyright: © 2021 ISPOR–The International Society for Pharmacoeconomics and Outcomes Research, Inc
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