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Cost-effectiveness and value of information analyses of neuraminidase inhibitors for the treatment of influenza

Cost-effectiveness and value of information analyses of neuraminidase inhibitors for the treatment of influenza
Cost-effectiveness and value of information analyses of neuraminidase inhibitors for the treatment of influenza
Objectives:

To assess the cost-effectiveness of alternative strategies for the treatment of suspected influenza in otherwise healthy adults and to identify future research priorities using value of information analysis.

Methods:

A decision model was used to estimate the costs and effects, in terms of quality-adjusted life-years (QALYs) of amantadine, zanamivir, and oseltamivir for the treatment of influenza in otherwise healthy adults using data predominantly from meta-analysis of randomized controlled trials. Probabilistic sensitivity analysis using Monte Carlo simulation was conducted. The expected value of perfect information for the entire model and for individual parameters was calculated.

Results:

Based on mean costs and effects, zanamivir is dominated by oseltamivir. The incremental cost-effectiveness ratio for amantadine (compared with no treatment) is £11,000 and £44,000 for oseltamivir (compared with amantadine). The probability that amantadine is cost-effective at a willingness to pay of £30,000 per QALY is 0.74, falling to 0.49 at £20,000 per QALY. Global expected value of perfect information (EVPI) is £2 m over 15 years if a willingness to pay threshold of £30,000 per QALY is assumed rising to £9.6 m at £45,000 per QALY. EVPI for only one parameter exceeds £500,0000 at £30,000 per QALY: the quality of life for untreated influenza.

Conclusions:

At traditionally accepted values of willingness to pay for health benefits, it is unlikely that additional research would be an efficient use of scarce resources. The only exception to this would be to examine the health-related quality of life impact of influenza in an untreated patient group. If a higher threshold value were acceptable, there are a small group of parameters that may warrant further investigation. These would, however, require comparative, potentially expensive, research studies.
cost-utility analysis, influenza, probabilistic sensitivity analysis, QALY, value of information
1098-3015
160-171
Wailoo, Alan J
3a66d1f6-6fbd-4a35-a21b-9cab49259370
Sutton, Alexander J
b85be336-9092-44fa-92c9-6547c913604d
Cooper, Nicola J
ba76d75f-f946-4b9f-8f99-8525565a1a75
Turner, David A
8f4b8e61-6bae-4b1f-b198-a1035359da76
Abrams, Keith R
f721ace8-fd4f-4d29-817b-b75c6f94157c
Brennan, Alan
5172d81f-9709-449f-850f-512ffe4cb21d
Nicholson, Karl G
27565fc2-15f9-44a4-a7df-d2ae6ecef0a6
Wailoo, Alan J
3a66d1f6-6fbd-4a35-a21b-9cab49259370
Sutton, Alexander J
b85be336-9092-44fa-92c9-6547c913604d
Cooper, Nicola J
ba76d75f-f946-4b9f-8f99-8525565a1a75
Turner, David A
8f4b8e61-6bae-4b1f-b198-a1035359da76
Abrams, Keith R
f721ace8-fd4f-4d29-817b-b75c6f94157c
Brennan, Alan
5172d81f-9709-449f-850f-512ffe4cb21d
Nicholson, Karl G
27565fc2-15f9-44a4-a7df-d2ae6ecef0a6

Wailoo, Alan J, Sutton, Alexander J, Cooper, Nicola J, Turner, David A, Abrams, Keith R, Brennan, Alan and Nicholson, Karl G (2008) Cost-effectiveness and value of information analyses of neuraminidase inhibitors for the treatment of influenza. Value in Health, 11 (2), 160-171. (doi:10.1111/j.1524-4733.2007.00241.x).

Record type: Article

Abstract

Objectives:

To assess the cost-effectiveness of alternative strategies for the treatment of suspected influenza in otherwise healthy adults and to identify future research priorities using value of information analysis.

Methods:

A decision model was used to estimate the costs and effects, in terms of quality-adjusted life-years (QALYs) of amantadine, zanamivir, and oseltamivir for the treatment of influenza in otherwise healthy adults using data predominantly from meta-analysis of randomized controlled trials. Probabilistic sensitivity analysis using Monte Carlo simulation was conducted. The expected value of perfect information for the entire model and for individual parameters was calculated.

Results:

Based on mean costs and effects, zanamivir is dominated by oseltamivir. The incremental cost-effectiveness ratio for amantadine (compared with no treatment) is £11,000 and £44,000 for oseltamivir (compared with amantadine). The probability that amantadine is cost-effective at a willingness to pay of £30,000 per QALY is 0.74, falling to 0.49 at £20,000 per QALY. Global expected value of perfect information (EVPI) is £2 m over 15 years if a willingness to pay threshold of £30,000 per QALY is assumed rising to £9.6 m at £45,000 per QALY. EVPI for only one parameter exceeds £500,0000 at £30,000 per QALY: the quality of life for untreated influenza.

Conclusions:

At traditionally accepted values of willingness to pay for health benefits, it is unlikely that additional research would be an efficient use of scarce resources. The only exception to this would be to examine the health-related quality of life impact of influenza in an untreated patient group. If a higher threshold value were acceptable, there are a small group of parameters that may warrant further investigation. These would, however, require comparative, potentially expensive, research studies.

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More information

Published date: 2008
Keywords: cost-utility analysis, influenza, probabilistic sensitivity analysis, QALY, value of information

Identifiers

Local EPrints ID: 146753
URI: http://eprints.soton.ac.uk/id/eprint/146753
ISSN: 1098-3015
PURE UUID: ccc53921-8c55-4054-9602-54be2f1340ab

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Date deposited: 22 Apr 2010 13:18
Last modified: 14 Mar 2024 00:57

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Contributors

Author: Alan J Wailoo
Author: Alexander J Sutton
Author: Nicola J Cooper
Author: David A Turner
Author: Keith R Abrams
Author: Alan Brennan
Author: Karl G Nicholson

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