Diagnostic testing or empirical neuraminidase inhibitor therapy for patients with influenza-like illness: what a difference a day makes.
OBJECTIVE
To determine the clinical and economic trade-offs of available diagnostic and treatment options for patients with suspected influenza infection.


METHODS
Decision analytic model.


METHODS
A simulated cohort of adults with influenza-like illness of less than 48 hours' duration.


METHODS
Patients received (1) no testing or treatment; (2) rapid testing for influenza, with neuraminidase inhibitors (NIs) prescribed for individuals who test positive; or (3) empirical NI therapy. A validated prediction rule to determine the probability of influenza infection based on patient signs and symptoms is available. The monetary value attributable to the incremental benefits of NI therapy must be quantified during the clinician visit.


RESULTS
Incremental cost per case of influenza treated with NIs.


RESULTS
The decision whether to treat, test, or prescribe NIs empirically for patients presenting with influenza-like illness of less than 48 hours' duration depends on the probability of influenza and the value of the benefits of NI therapy. If the incremental value of NI therapy exceeds $200 and the probability of influenza is greater than 35%, empiric NI therapy is the preferred option. The test option has a very narrow band of preference due to suboptimal test characteristics and cost.


CONCLUSIONS
The decision whether to prescribe NIs based on clinical criteria or restrict NI use to patients with a confirmed laboratory diagnosis of influenza depends on the likelihood of infection, the accuracy and cost of the diagnostic test, and the benefits attributable to NI therapy. Clinicians must consider these factors when determining cost-effective use of NIs.
Blitz
Susan G
SG
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, USA.
Cram
Peter
P
Chernew
Michael E
ME
Monto
Arnold S
AS
Fendrick
A Mark
AM
D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D003937:Diagnosis, Differential; D004791:Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics / Q000201:enzymology; D009439:Neuraminidase / Q000037:antagonists & inhibitors* / Q000191:economics; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D004791:Enzyme Inhibitors; D009439:Neuraminidase