title: Cost-effectiveness analysis of antiviral treatment in the management of seasonal influenza A: point-of-care rapid test versus clinical judgment.
abstract: BACKGROUND
  A point-of-care rapid test (POCRT) may help early and targeted use of antiviral drugs for the management of influenza A infection.
  
  
  OBJECTIVE
  (i) To determine whether antiviral treatment based on a POCRT for influenza A is cost-effective and, (ii) to determine the thresholds of key test parameters (sensitivity, specificity and cost) at which a POCRT based-strategy appears to be cost effective.
  
  
  METHODS
  An hybrid « susceptible, infected, recovered (SIR) » compartmental transmission and Markov decision analytic model was used to simulate the cost-effectiveness of antiviral treatment based on a POCRT for influenza A in the social perspective. Data input parameters used were retrieved from peer-review published studies and government databases. The outcome considered was the incremental cost per life-year saved for one seasonal influenza season.
  
  
  RESULTS
  In the base-case analysis, the antiviral treatment based on POCRT saves 2 lives/100,000 person-years and costs $7600 less than the empirical antiviral treatment based on clinical judgment alone, which demonstrates that the POCRT-based strategy is dominant. In one and two way-sensitivity analyses, results were sensitive to the POCRT accuracy and cost, to the vaccination coverage as well as to the prevalence of influenza A. In probabilistic sensitivity analyses, the POCRT strategy is cost-effective in 66% of cases, for a commonly accepted threshold of $50,000 per life-year saved.
  
  
  CONCLUSIONS
  The influenza antiviral treatment based on POCRT could be cost-effective in specific conditions of performance, price and disease prevalence.
authors.affiliation: Faculté de Médecine, Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada.
authors.forename: Léon
authors.initials: L
authors.lastname: Nshimyumukiza
authors.affiliation: Faculté des sciences et génie, Département de génie électrique, Université Laval, Québec, QC, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Douville
authors.affiliation: Faculté des sciences et génie, Département de génie électrique, Université Laval, Québec, QC, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Fournier
authors.affiliation: Faculté de Médecine, Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Duplantie
authors.affiliation: Centre de recherche en infectiologie (CRI), CHU de Québec (CHUQ), Québec, QC, Canada.
authors.forename: Rana K
authors.initials: RK
authors.lastname: Daher
authors.affiliation: Centre de recherche en infectiologie (CRI), CHU de Québec (CHUQ), Québec, QC, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Charlebois
authors.affiliation: Centre de recherche en infectiologie (CRI), CHU de Québec (CHUQ), Québec, QC, Canada.|Faculté de médecine, Département de microbiologie-infectiologie et d'immunologie, Université Laval, Québec, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Longtin
authors.affiliation: Faculté de Médecine, Département de pédiatrie, Université McGill, Montréal, QC, Canada.
authors.forename: Jesse
authors.initials: J
authors.lastname: Papenburg
authors.affiliation: Faculté de médecine, Département des sciences de la santé communautaire, Université de Sherbrooke, Longueuil, QC, Canada.
authors.forename: Maryse
authors.initials: M
authors.lastname: Guay
authors.affiliation: Faculté de sciences et de génie, Département de physique, génie physique et d'optique, Université Laval, Québec, QC, Canada.
authors.forename: Maurice
authors.initials: M
authors.lastname: Boissinot
authors.affiliation: Centre de recherche en infectiologie (CRI), CHU de Québec (CHUQ), Québec, QC, Canada.|Faculté de médecine, Département de microbiologie-infectiologie et d'immunologie, Université Laval, Québec, QC, Canada.
authors.forename: Michel G
authors.initials: MG
authors.lastname: Bergeron
authors.affiliation: Faculté de sciences et de génie, Département de chimie, Université Laval, Québec, QC, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Boudreau
authors.affiliation: Faculté des sciences et génie, Département de génie électrique, Université Laval, Québec, QC, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Gagné
authors.affiliation: Faculté de médecine, Département de biologie moléculaire, biochimie médicale et pathologie, Université Laval, Québec, QC, Canada.|Unité de recherche en génétique humaine et moléculaire, Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec (CHUQ), Québec, QC, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Rousseau
authors.affiliation: Faculté de Médecine, Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reinharz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D002648:Child; D003362:Cost-Benefit Analysis; D019468:Disease Management; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000821:virology; D007600:Judgment; D008875:Middle Aged; D015233:Models, Statistical; D019095:Point-of-Care Systems; D012621:Seasons; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: Antiviral treatment; cost effectiveness; point-of-care rapid test; seasonal influenza; simulation