Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries
Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries
Background: Oseltamivir is usually not often prescribed (or reimbursed) for non-high-risk patients consulting for influenza-like-illness (ILI) in primary care in Europe. We aimed to evaluate the cost-effectiveness of adding oseltamivir to usual primary care in adults/adolescents (13 years +) and children with ILI during seasonal influenza epidemics, using data collected in an open-label, multi-season, randomised controlled trial of oseltamivir in 15 European countries. Methods: Direct and indirect cost estimates were based on patient reported resource use and official country-specific unit costs. Health-Related Quality of Life was assessed by EQ-5D questionnaires. Costs and quality adjusted life-years (QALY) were bootstrapped (N = 10,000) to estimate incremental cost-effectiveness ratios (ICER), from both the healthcare payers’ and the societal perspectives, with uncertainty expressed through probabilistic sensitivity analysis and expected value for perfect information (EVPI) analysis. Additionally, scenario (self-reported spending), comorbidities subgroup and country-specific analyses were performed. Results: The healthcare payers’ expected ICERs of oseltamivir were €22,459 per QALY gained in adults/adolescents and €13,001 in children. From the societal perspective, oseltamivir was cost-saving in adults/adolescents, but the ICER is €8,344 in children. Large uncertainties were observed in subgroups with comorbidities, especially for children. The expected ICERs and extent of decision uncertainty varied between countries (EVPI ranged €1–€35 per patient). Conclusion: Adding oseltamivir to primary usual care in Europe is likely to be cost-effective for treating adults/adolescents and children with ILI from the healthcare payers’ perspective (if willingness-to-pay per QALY gained > €22,459) and cost-saving in adults/adolescents from a societal perspective.
Cost-utility analysis, Direct cost, Europe, ILI, Indirect cost, Multi-country, Productivity losses, QALY, Tamiflu
Li, Xiao
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Bilcke, Joke
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van der Velden, Alike W
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Bruyndonckx, Robin
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Coenen, Samuel
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Bongard, Emily
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de Paor, Muirrean
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Chlabicz, Slawomir
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Godycki-Cwirko, Maciek
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Francis, Nick
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Aabenhus, Rune
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Bucher, Heiner C
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Colliers, Annelies
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De Sutter, An
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Garcia-Sangenis, Ana
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Glinz, Dominik
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Harbin, Nicolay J.
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Kosiek, Katarzyna
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Lindbæk, Morten
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Lionis, Christos
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Llor, Carl
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Mikó-Pauer, Réka
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Radzeviciene Jurgute, Ruta
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Seifert, Bohumil
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Sundvall, Pär-Daniel
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Touboul Lundgren, Pia
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Tsakountakis, Nikolaos
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Verheij, Theo J.
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Goossens, Herman
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Butler, Christopher C.
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Beutels, Philippe
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ALIC4Etrial investigators
22 September 2022
Li, Xiao
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Bilcke, Joke
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van der Velden, Alike W
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Bruyndonckx, Robin
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Coenen, Samuel
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Bongard, Emily
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de Paor, Muirrean
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Chlabicz, Slawomir
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Godycki-Cwirko, Maciek
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Francis, Nick
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Aabenhus, Rune
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Bucher, Heiner C
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Colliers, Annelies
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De Sutter, An
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Garcia-Sangenis, Ana
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Glinz, Dominik
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Harbin, Nicolay J.
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Kosiek, Katarzyna
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Lindbæk, Morten
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Lionis, Christos
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Llor, Carl
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Mikó-Pauer, Réka
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Radzeviciene Jurgute, Ruta
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Seifert, Bohumil
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Sundvall, Pär-Daniel
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Touboul Lundgren, Pia
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Tsakountakis, Nikolaos
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Verheij, Theo J.
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Goossens, Herman
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Butler, Christopher C.
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Beutels, Philippe
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