title: Economic model for emergency use authorization of intravenous peramivir.
abstract: OBJECTIVE
  To develop 3 computer simulation models to determine the potential economic effect of using intravenous (IV) antiviral agents to treat hospitalized patients with influenza-like illness, as well as different testing and treatment strategies.
  
  
  METHODS
  Stochastic decision analytic computer simulation model.
  
  
  METHODS
  During the 2009 influenza A(H1N1) pandemic, the Food and Drug Administration granted emergency use authorization of IV neuraminidase inhibitors for hospitalized patients with influenza, creating a need for rapid decision analyses to help guide use. We compared the economic value from the societal and third-party payer perspectives of the following 4 strategies for a patient hospitalized with influenza-like illness and unable to take oral antiviral agents: Strategy 1: Administration of IV antiviral agents without polymerase chain reaction influenza testing. Strategy 2: Initiation of IV antiviral treatment, followed by polymerase chain reaction testing to determine whether the treatment should be continued. Strategy 3: Performance of polymerase chain reaction testing, followed by initiation of IV antiviral treatment if the test results are positive. Strategy 4: Administration of no IV antiviral agents. Sensitivity analyses varied the probability of having influenza (baseline, 10%; range, 10%-30%), IV antiviral efficacy (baseline, oral oseltamivir phosphate; range, 25%-75%), IV antiviral daily cost (range, $20-$1000), IV antiviral reduction of illness duration (baseline, 1 day; range, 1-2 days), and ventilated vs nonventilated status of the patient.
  
  
  RESULTS
  When the cost of IV antiviral agents was no more than $500 per day, the incremental cost-effectiveness ratio for most of the IV antiviral treatment strategies was less than $10,000 per quality-adjusted life-year compared with no treatment. When the cost was no more than $100 per day, all 3 IV antiviral strategies were even more cost-effective. The order of cost-effectiveness from most to least was strategies 3, 1, and 2. The findings were robust to changing risk of influenza, influenza mortality, IV antiviral efficacy, IV antiviral daily cost, IV antiviral reduction of illness duration, and ventilated vs nonventilated status of the patient for both societal and third-party payer perspectives.
  
  
  CONCLUSIONS
  Our study supports the use of IV antiviral treatment for hospitalized patients with influenza-like illness.
authors.affiliation: Public Health Computational and Operations Research, University of Pittsburgh School of Medicine and Graduate School of Public Health, PA 15213, USA. byl1@pitt.edu
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: Julie H Y
authors.initials: JH
authors.lastname: Tai
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Bailey
authors.forename: Sarah M
authors.initials: SM
authors.lastname: McGlone
authors.forename: Ann E
authors.initials: AE
authors.lastname: Wiringa
authors.forename: Shanta M
authors.initials: SM
authors.lastname: Zimmer
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
mesh_terms: D000146:Acids, Carbocyclic; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003198:Computer Simulation; D016001:Confidence Intervals; D003517:Cyclopentanes / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003661:Decision Support Techniques; D005260:Female; D006146:Guanidines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000188:drug therapy* / Q000191:economics; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015233:Models, Statistical; D009010:Monte Carlo Method; D016133:Polymerase Chain Reaction; D019057:Quality-Adjusted Life Years; D013269:Stochastic Processes; D014481:United States; D055815:Young Adult
chemical_list: D000146:Acids, Carbocyclic; D000998:Antiviral Agents; D003517:Cyclopentanes; D006146:Guanidines; C414210:peramivir