title: Cost-effectiveness analysis of oseltamivir for influenza treatment considering the virus emerging resistant to the drug in Japan.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the cost-effectiveness of oseltamivir for influenza in Japan considering the complications and the emergence of oseltamivir-resistant virus.
  
  
  METHODS
  Study design is a cost-effectiveness analysis in decision analytic modeling based on previously published evidence. Outcome measures included costs and quality-adjusted life year (QALY).
  
  
  CONCLUSIONS
  In the base-case analysis, the incremental cost-effectiveness ratio (ICER) of oseltamivir during influenza and complications was JPY398,571 ($3320) per QALY without productivity loss, which implied oseltamivir is evidently cost-effective. Furthermore, considering the productivity loss, the ICER for oseltamivir turned to be negative, which means simply dominant. When the prevalence was in the low range of 10% to 38%, oseltamivir became less cost-effective than conventional treatment. Regarding potential emergence of the drug-resistant virus, we found the dominance of oseltamivir will vanish if the emerging rate becomes larger than 27%. The two-way sensitivity analysis also suggested that if the resistant virus rate becomes less and the prevalence higher, then oseltamivir becomes more advantageous. The analysis for uncertainty, using cost-effectiveness acceptability curve by Monte Carlo simulation, resulted in the estimate of about 80% chance that oseltamivir could be cost-effective at the willingness-to-pay level of JPY6,000,000 ($50,000), which is commonly accepted as an affordable threshold.
authors.affiliation: Division of Medical Statistics, Graduate School of Medicine, Kobe University, Kobe, Japan. nagase@med.kobe-u.ac.jp
authors.forename: Hiroko
authors.initials: H
authors.lastname: Nagase
authors.forename: Kensuke
authors.initials: K
authors.lastname: Moriwaki
authors.forename: Maki
authors.initials: M
authors.lastname: Kamae
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yanagisawa
authors.forename: Isao
authors.initials: I
authors.lastname: Kamae
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D024882:Drug Resistance, Viral; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy* / Q000191:economics*; D007564:Japan; D018803:Models, Economic; D053139:Oseltamivir / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir