Program Schedule

Oseltamivir use in an Influenza Outbreak: Linking Pharmacology to Pharmacoeconomics

Session: Poster Abstract Session: Public Health
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • IDSAposter Rayner - FINAL.pdf (526.2 kB)
  • Background: Recent pharmacokinetic/pharmacodynamic (PK/PD) evaluations find that higher oseltamivir exposures may reduce duration of viral shedding and symptoms.  However, the impact of such findings on pandemic planning decisions and use of stockpiles has not been described. This study explored the economic impact of oseltamivir dose optimization in supporting pandemic influenza planning decisions in the US.

    Methods: We simulated the infected population across a 1 year seasonal influenza outbreak using a health economic model linked to a PK/PD-epidemiology model (SEIR). Different scenarios were considered to evaluate the cost-effectiveness of high dose (150mg BID) vs standard dose (75mg BID) oseltamivir, low and high virulence, varying transmissibility (low and high attack rates (37% and 67.5% respectively)) and drug uptake (25%, 50%, and 80%). The analysis was conducted from a societal perspective, incorporating both direct and indirect costs. Disease epidemiology and costs were US-specific. Sensitivity analyses were performed to test model robustness.

    Results: Results for incremental cost, deaths averted, quality-adjusted life-years (QALY) gained, and incremental cost-effectiveness ratios (ICERs) for high dose compared with standard dose oseltamivir under different scenarios are given in Table.

    Comparators (150 mg vs. 75 mg) Incremental cost (USD)3 Death averted QALY gained ICER(per QALY)
    High virulence1 
     high transmissibility  
    25%2  -21,935,208 148.4 149.1 -147,108
    50%2  -31,673,695 227 227.2 -139,384
    80%2  -21,126,363 190 189.4 -111,573
     low transmissibility  
    25%2  -4,212,570 44.3 44.5 -94,729
    50%2  4,335,233 13.7 13.7 317,341
    80%2  9,116,920 9 9 1,015,910
    Low  virulence
    high transmissibility  
    25%2  -14,661,284 74.5 77.2 -190,011
    50%2  -20,562,861 114 117.2 -175,496
    80%2  -11,842,304 95.4 97.2 -121,822
     low transmissibility  
    25%2  -2,043,215 22.2 23 -88,790
    50%2  5,003,199 6.9 7 710,268
    80%2  9,556,934 4.5 4.6 2,074,257

     1 Proportion of infected cases who visited ED was assumed to be twice as high as in low severity scenario  2 Uptake   3negative signs mean cost-saving

     Conclusion: These results suggest the potential for high dose oseltamivir to provide economic value, and may have a role in pandemic influenza particularly in high transmissability scenarios; the role of high dose oseltamivir should be investigated further.

    Nathorn Chaiyakunapruk, PharmD PhD1, David Wu, PhD1, Chayanin Pratoomsoot1, Kenneth Lee, PhD1, Huey Chong Yi1, Richard E. Nelson, PhD2, Patrick Smith, PharmD3, Carl Kirkpatrick, PhD4, Mohamed Kamal, PharmD PhD5, Keith Nieforth, PharmD3, Georgina Dall, PharmD3, Stephen Toovey, MD PhD6, David Kong, PhD4, Aaron Kamauu, MD MS MPH7 and Craig Rayner, PharmD MBA3, (1)Monash University, Selangor, Malaysia, (2)Internal Medicine, University of Utah, Salt Lake City, UT, (3)D3 Medicine, Parsippany, NJ, (4)Pharmacy Practice, Monash University, Parkville, Australia, (5)Roche, New York, NY, (6)Pegasus Research, Bottmingen, Switzerland, (7)Anolinx, Murray, UT


    N. Chaiyakunapruk, Roche: Grant Investigator, Consulting fee and Research grant

    D. Wu, Roche: Grant Investigator, Research grant

    C. Pratoomsoot, Roche: Collaborator, Research grant and Research support

    K. Lee, Roche: Consultant, Consulting fee

    H. C. Yi, Roche: Research Contractor, Research grant and Research support

    R. E. Nelson, Roche: Consultant and Grant Investigator, Consulting fee, Research grant and Research support

    P. Smith, Roche: Grant Investigator, Consulting fee

    C. Kirkpatrick, Roche: Consultant, Consulting fee

    M. Kamal, Roche: Employee, Salary

    K. Nieforth, Roche: Consultant, Consulting fee

    G. Dall, Roche: Consultant, Consulting fee

    S. Toovey, Roche: Consultant, Consulting fee

    D. Kong, Roche: Consultant, Consulting fee

    A. Kamauu, Roche: Consultant and Grant Investigator, Consulting fee and Research support

    C. Rayner, Roche: Research Contractor, Consulting fee

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