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The European Journal of Health Economics
Published in: The European Journal of Health Economics 6/2023

Open Access 22-09-2022 | Oseltamivir | Original Paper

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

Authors: 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, Philippe Beutels, ALIC4Etrial investigators

Published in: The European Journal of Health Economics | Issue 6/2023

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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.
Appendix
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Metadata
Title
Cost-effectiveness of adding oseltamivir to primary care for influenza-like-illness: economic evaluation alongside the randomised controlled ALIC4E trial in 15 European countries
Authors
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
Philippe Beutels
ALIC4Etrial investigators
Publication date
22-09-2022
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 6/2023
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-022-01521-2

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