Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries.
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; ALIC4Etrial investigators
(2023) The European journal of health economics : HEPAC : health economics in prevention and care, volume 24, issue 6, pp. 909 - 922
(Article)
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
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an open-label, multi-season, randomised controlled trial of oseltamivir in 15 European countries. METHODS: Direct 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. RESULTS: The 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). CONCLUSION: Adding 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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Keywords: Cost-utility analysis, Direct cost, Europe, ILI, Indirect cost, Multi-country, Productivity losses, QALY, Tamiflu, Economics, Econometrics and Finance (miscellaneous), Health Policy, Journal Article
ISSN: 1618-7598
Publisher: Springer-Verlag
Note: Funding Information: The ALIC4E trial and the contributions of AWV, SC, EB, MDP, SCh, MGC, NF, RA, HCB, AC, ADS, AGS, DG, NJH, KK, ML, CL, CaL, RMP, RRJ, BS, PDS, PTL, NT, TJV, HG, CCB and PB were funded by the European Commission’s Seventh Framework Programme: Platform for European Preparedness Against (Re-)emerging Epidemics (PREPARE) (grant HEALTH-F3-2013-602525). PB, XL, JB and RB acknowledge partial Methusalem funding from the VAX-IDEA and ASCID Centres of Excellence in vaccination and infectious diseases at the University of Antwerp. JB and RB were funded by their personal postdoctoral grants from the Research Foundation—Flanders (FWO). PDS acknowledges that The Healthcare Committee, Region Västra Götaland, Sweden, partially funded the Swedish part of the study. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Funding Information: CCB reports grants from National Institute for Health Research Health and grants from National Institute for Health Research Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance during the conduct of the study; personal fees from Roche Molecular Systems, grants from Roche Molecular Diagnostics, personal fees from Pfizer, personal fees from Roche diagnostics, personal fees from Janssen Pharmaceuticals, outside the submitted work. DG reports to be employed since June 1, 2020, by Roche Pharma (Schweiz) AG, Basel, Switzerland. Data collections for this manuscript have been completed before his current employment. PB reports grants from European commission IMI, outside the submitted work. NF reports grants from NIHR and Synairgen, consultancy fees from GSK, presenters fees from Abbott and holding stock of Synairgen and AstraZeneca, outside of this submitted work. PDS declares that the Healthcare Committee, Region Västra Götaland, Sweden, partially funded the Swedish part of the study. CL reports grants from Oxford University outside of the submitted work. All other authors declare no competing interests. Publisher Copyright: © 2022, The Author(s).
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