Antiviral medications for pregnant women for pandemic and seasonal influenza: an economic computer model.
OBJECTIVE
To estimate the economic value of administering antiviral medications to pregnant women who have come in contact with an infectious individual with influenza.


METHODS
A computer-simulation model was developed to predict the potential economic effect of antiviral use for postexposure prophylaxis among pregnant women in both seasonal influenza and pandemic influenza scenarios. The model allowed us to examine the effects of varying influenza exposure risk, antiviral efficacy, antiviral cost, and the probability of different influenza outcomes such as hospitalization, preterm delivery, and mortality.


RESULTS
For a variety of pandemic influenza scenarios (attack rate 20% or more, probability of preterm birth for women with influenza 12% or more, mortality for a preterm neonate 2% or more, and probability of influenza-attributable hospitalization 4.8% or more), the postexposure prophylactic use of antiviral medications was strongly cost-effective, with incremental cost-effectiveness ratio values below $50,000 per quality-adjusted life-year. Antiviral prophylaxis became an economically dominant strategy (that is, less costly and more effective) when the influenza attack rate is 20% or more and preterm birth rate is 36% or more, and when attack rate is 30% or more and preterm birth rate is 24% or more. Antiviral prophylaxis was not cost-effective under seasonal influenza conditions.


CONCLUSIONS
These findings support the use of antiviral medications for postexposure prophylaxis among pregnant women in a pandemic influenza scenario but not in a seasonal influenza setting.
Lee
Bruce Y
BY
From the Section of Decision Sciences and Clinical Systems Modeling, School of Medicine; Department of Biomedical Informatics, School of Medicine; Department of Epidemiology, Graduate School of Public Health; and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
Bailey
Rachel R
RR
Wiringa
Ann E
AE
Assi
Tina-Marie
TM
Beigi
Richard H
RH
D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004196:Disease Outbreaks; D016527:Drug Costs; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007251:Influenza, Human / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D018803:Models, Economic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000517:prevention & control / Q000821:virology*; D047928:Premature Birth / Q000191:economics / Q000821:virology; D012621:Seasons
D000998:Antiviral Agents