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Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries

Author

Listed:
  • Xiao Li

    (University of Antwerp)

  • Joke Bilcke

    (University of Antwerp)

  • Alike W. van der Velden

    (University Medical Center)

  • Robin Bruyndonckx

    (Hasselt University
    University of Antwerp)

  • Samuel Coenen

    (University of Antwerp
    University of Antwerp)

  • Emily Bongard

    (University of Oxford)

  • Muirrean de Paor

    (RCSI Department of General Practice)

  • Slawomir Chlabicz

    (Medical University of Bialystok)

  • Maciek Godycki-Cwirko

    (Medical University of Lodz)

  • Nick Francis

    (University of Southampton)

  • Rune Aabenhus

    (University of Copenhagen)

  • Heiner C. Bucher

    (University Hospital Basel)

  • Annelies Colliers

    (University of Antwerp)

  • An De Sutter

    (Gent University)

  • Ana Garcia-Sangenis

    (University Institute in Primary Care Research Jordi Gol)

  • Dominik Glinz

    (University Hospital Basel)

  • Nicolay J. Harbin

    (University of Oslo)

  • Katarzyna Kosiek

    (Family Doctors’ Clinic)

  • Morten Lindbæk

    (University of Oslo)

  • Christos Lionis

    (University of Crete)

  • Carl Llor

    (University Institute in Primary Care Research Jordi Gol
    University of Copenhagen)

  • Réka Mikó-Pauer

    (DRC Drug Research Center LLC)

  • Ruta Radzeviciene Jurgute

    (FDC Mano šeimos gydytojas)

  • Bohumil Seifert

    (Charles University in Prague)

  • Pär-Daniel Sundvall

    (Sahlgrenska Academy, University of Gothenburg
    Primary Health Care, Region Västra Götaland)

  • Pia Touboul Lundgren

    (Hôpital de l’Archet)

  • Nikolaos Tsakountakis

    (Malia Surgery, Kastelli HC)

  • Theo J. Verheij

    (University Medical Center)

  • Herman Goossens

    (University of Antwerp)

  • Christopher C. Butler

    (University of Oxford)

  • Philippe Beutels

    (University of Antwerp)

Abstract

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.

Suggested Citation

  • Xiao Li & Joke Bilcke & Alike W. van der Velden & Robin Bruyndonckx & Samuel Coenen & Emily Bongard & Muirrean de Paor & Slawomir Chlabicz & Maciek Godycki-Cwirko & Nick Francis & Rune Aabenhus & Hein, 2023. "Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(6), pages 909-922, August.
    • Handle: RePEc:spr:eujhec:v:24:y:2023:i:6:d:10.1007_s10198-022-01521-2
    DOI: 10.1007/s10198-022-01521-2
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    References listed on IDEAS

    as
    1. James C. Felli & Gordon B. Hazen, 1998. "Sensitivity Analysis and the Expected Value of Perfect Information," Medical Decision Making, , vol. 18(1), pages 95-109, January.
    2. Joke Bilcke & Samuel Coenen & Philippe Beutels, 2014. "Influenza-Like-Illness and Clinically Diagnosed Flu: Disease Burden, Costs and Quality of Life for Patients Seeking Ambulatory Care or No Professional Care at All," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-11, July.
    3. Zoë Pieters & Mark Strong & Virginia E. Pitzer & Philippe Beutels & Joke Bilcke, 2020. "A Computationally Efficient Method for Probabilistic Parameter Threshold Analysis for Health Economic Evaluations," Medical Decision Making, , vol. 40(5), pages 669-679, July.
    4. Beate Sander & Marlene Gyldmark & Frederick Hayden & James Morris & Elvira Mueller & Rito Bergemann, 2005. "Influenza treatment with neuraminidase inhibitors," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(3), pages 244-252, September.
    5. Elisabeth Fenwick & Andrew Briggs, 2007. "Cost-Effectiveness Acceptability Curves in the Dock," Medical Decision Making, , vol. 27(2), pages 93-95, March.
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    More about this item

    Keywords

    Tamiflu; Cost-utility analysis; Europe; Multi-country; QALY; ILI; Direct cost; Indirect cost; Productivity losses;
    All these keywords.

    JEL classification:

    • I19 - Health, Education, and Welfare - - Health - - - Other

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