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

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 (), Heiner C. Bucher (), Annelies Colliers (), An De Sutter (), Ana Garcia-Sangenis (), Dominik Glinz (), Nicolay J. Harbin (), Katarzyna Kosiek (), Morten Lindbæk (), Christos Lionis (), Carl Llor (), Réka Mikó-Pauer (), Ruta Radzeviciene Jurgute (), Bohumil Seifert (), Pär-Daniel Sundvall (), Pia Touboul Lundgren (), Nikolaos Tsakountakis (), Theo J. Verheij (), Herman Goossens (), Christopher C. Butler () and Philippe Beutels ()
Additional contact information
Xiao Li: University of Antwerp
Joke Bilcke: University of Antwerp
Alike W. van der Velden: University Medical Center
Robin Bruyndonckx: Hasselt University
Samuel Coenen: 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
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
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

The European Journal of Health Economics, 2023, vol. 24, issue 6, No 6, 909-922

Abstract: 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.

Keywords: Tamiflu; Cost-utility analysis; Europe; Multi-country; QALY; ILI; Direct cost; Indirect cost; Productivity losses (search for similar items in EconPapers)
JEL-codes: I19 (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1007/s10198-022-01521-2

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