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J Am Geriatr Soc. 2005 Mar;53(3):444-51.

Economic evaluation of oseltamivir phosphate for postexposure prophylaxis of influenza in long-term care facilities.

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1
Health Outcomes and PharmacoEconomics Research Center, Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada. nancy.risenbrough@sw.ca

Abstract

OBJECTIVES:

To compare the cost-effectiveness of oseltamivir postexposure prophylaxis during influenza A outbreaks with that of amantadine postexposure prophylaxis or no postexposure prophylaxis in long-term care facilities (LTCFs).

DESIGN:

Cost-effectiveness analysis based on decision analytic model from a government-payer perspective.

SETTING:

A Canadian LTCF, with high staff vaccination, at the beginning of influenza season.

PARTICIPANTS:

Elderly, influenza-vaccinated patients living in a Canadian LTCF.

MEASUREMENTS:

Incremental costs (or savings) per influenza-like illness case avoided compared with usual care.

RESULTS:

From a government-payer perspective, this analysis showed that oseltamivir was a dominant strategy because it was associated with the fewest influenza-like illness cases, with cost savings of $1,249 per 100 patients in 2001 Canadian dollars compared with amantadine and $3,357 per 100 patients compared with no prophylaxis. Costs for amantadine dose calculation and hospitalization for adverse events contributed to amantadine being a more-expensive prophylaxis strategy than oseltamivir. Both prophylaxis strategies were more cost-effective than no prophylaxis.

CONCLUSION:

Despite high influenza vaccination rates, influenza outbreaks continue to emerge in LTCFs, necessitating cost-effective measures to further limit the spread of influenza and related complications. Although amantadine has a lower acquisition cost than oseltamivir, it is associated with more adverse events, lower efficacy, and individualized dosing requirements, leading to higher overall costs and more influenza-like illness cases than oseltamivir. Therefore the use of oseltamivir postexposure prophylaxis is more cost-effective than the current standard of care with amantadine prophylaxis or no prophylaxis.

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