Management of influenza symptoms in healthy children: cost-effectiveness of rapid testing and antiviral therapy.
OBJECTIVE
To determine the cost-effectiveness of rapid testing and antiviral therapy for children of different ages with symptoms of influenza.


METHODS
Cost-effectiveness analysis from the societal perspective using a decision model based on published data.


METHODS
Physician's office during an influenza A epidemic.


METHODS
Hypothetical children aged 2, 7, and 15 years.


METHODS
Rapid testing or clinical diagnosis followed by treatment with amantadine hydrochloride or oseltamivir phosphate compared with no antiviral therapy.


METHODS
Costs and quality-adjusted life expectancy.


RESULTS
Empirical therapy with antiviral medication resulted in the greatest quality-adjusted life expectancy in all age groups. Compared with not treating, antiviral therapy improved quality-adjusted life expectancy by 0.003 quality-adjusted life-year by shortening the duration of illness and preventing otitis media. In young children it saved up to USD 121 per child mostly by avoiding parental work loss. Excluding work loss, antiviral therapy improved quality-adjusted life expectancy at a cost of USD 800 to 1800 per quality-adjusted life-year saved. Compared with amantadine, oseltamivir was not cost-effective when influenza A predominated. The incremental cost-effectiveness of oseltamivir fell below USD 50 000 per quality-adjusted life-year saved when the proportion of influenza B exceeded 14% for a 2-year-old, 27% for a 7-year-old, or 43% for a 15-year-old. Rapid testing was cost-effective only when the probability of influenza was 60% or less.


CONCLUSIONS
For children presenting with influenza symptoms during a local influenza outbreak, treatment with antiviral therapy appears to offer the best outcome and often saves money. The choice of antiviral drug should be based on the prevalence of influenza B.
Rothberg
Michael B
MB
Division of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA. Michael.Rothberg@bhs.org
Fisher
Donna
D
Kelly
Brendan
B
Rose
David N
DN
D000293:Adolescent; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D019057:Quality-Adjusted Life Years
D000998:Antiviral Agents