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J Pediatr. 2012 Jan;160(1):67-73.e6. doi: 10.1016/j.jpeds.2011.07.001. Epub 2011 Sep 13.

Cost-effectiveness of oseltamivir treatment for children with uncomplicated seasonal influenza.

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Harvard University, Cambridge, MA, USA.



To evaluate the cost-effectiveness of oseltamivir treatment for seasonal influenza in children and consider the impact of oseltamivir resistance on these findings.


We developed a model to evaluate 1-year clinical and economic outcomes associated with 3 outpatient management strategies for unvaccinated children with influenza-like-illness: no antiviral treatment; diagnostic testing and oseltamivir treatment when positive; and empiric oseltamivir treatment. The model depicted a hypothetical non-pandemic influenza season with a 29% level of oseltamivir resistance in circulating viruses, and 14% to 54% probability of seasonal influenza with influenza-like-illness. Strategies were compared with incremental cost-effectiveness ratios.


In our primary analysis, empiric oseltamivir treatment consistently produced the greatest benefit. The incremental cost-effectiveness of this alternative, compared with testing and treating, was <$100,000 per quality-adjusted life year gained in all age groups except the oldest. The testing strategy was consistently more effective compared with no treatment and cost between $25,900 and $71,200 per quality-adjusted life year gained, depending on age. Results were sensitive to the prevalence of oseltamivir resistance in circulating viruses.


Empiric oseltamivir treatment of seasonal influenza is associated with favorable cost-effectiveness ratios, particularly in children aged 1 to <12 years, but ratios are highly dependent on the prevalence of oseltamivir resistance among circulating influenza viruses.

[Indexed for MEDLINE]

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