Economic analysis of influenza vaccination and antiviral treatment for healthy working adults.
BACKGROUND
Physicians have several treatment options for influenza, including vaccination and various antiviral therapies. However, the optimal influenza prevention and treatment strategy is unknown.


OBJECTIVE
To compare the relative health values of contemporary treatment strategies for influenza in a healthy sample of working adults.


METHODS
Cost-benefit analysis using a decision model.


METHODS
Previously published data.


METHODS
Healthy employed adults 18 to 50 years of age.


METHODS
A complete influenza season.


CONCLUSIONS
Societal.


METHODS
Eight treatment options (yes or no) based on the possible combinations of vaccination and antiviral therapy (rimantadine, oseltamivir, or zanamivir or no treatment) should infection develop.


METHODS
Cost in U.S. dollars, including the value of symptom relief and medication side effects, which was assigned a monetary value through a conjoint analysis that used a "willingness-to-pay" approach.


RESULTS
In the base-case analysis, all strategies for influenza vaccination had a higher net benefit than the nonvaccination strategies. Vaccination and use of rimantadine, the most cost-beneficial strategy, was $30.97 more cost-beneficial than nonvaccination and no use of antiviral medication. The health benefits of most antiviral treatments equaled or exceeded their costs for most scenarios. The choice of the most cost-beneficial antiviral strategy was sensitive to the prevalence of influenza B and to the comparative workdays gained by each antiviral therapy.


CONCLUSIONS
Vaccination is cost-beneficial in most influenza seasons in healthy working adults. Although the benefits of antiviral therapy for persons with influenza infection appear to justify its cost, head-to-head trials of the various antiviral therapies are needed to determine the optimal treatment strategy.
Lee
Patrick Y
PY
Duke University and the Durham Veterans Affairs Medical Center, Durham, North Carolina 27708, USA.
Matchar
David B
DB
Clements
Dennis A
DA
Huber
Joel
J
Hamilton
John D
JD
Peterson
Eric D
ED
D000081:Acetamides / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003198:Computer Simulation; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016527:Drug Costs; D006146:Guanidines; D006801:Humans; D007252:Influenza Vaccines / Q000191:economics*; D007251:Influenza, Human / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control*; D008875:Middle Aged; D053139:Oseltamivir; D011714:Pyrans; D012299:Rimantadine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D012794:Sialic Acids / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D014611:Vaccination / Q000191:economics*; D053243:Zanamivir
D000081:Acetamides; D000998:Antiviral Agents; D006146:Guanidines; D007252:Influenza Vaccines; D011714:Pyrans; D012794:Sialic Acids; D012299:Rimantadine; D053139:Oseltamivir; D053243:Zanamivir