Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 17, Number 9—September 2011
Research

Estimating Effect of Antiviral Drug Use during Pandemic (H1N1) 2009 Outbreak, United States

Charisma Y. Atkins, Anita Patel, Thomas H. Taylor, Matthew Biggerstaff, Toby L. Merlin, Stephanie M. Dulin, Benjamin A. Erickson, Rebekah H. Borse, Robert Hunkler, and Martin I. Meltzer
Author affiliations: Author affiliations: Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.Y. Atkins, A. Patel, T.H. Taylor, Jr., M. Biggerstaff, T.L. Merlin, S.M. Dulin, B.A. Erikson, R.H. Borse, M.I. Meltzer); IMS Health, Fountain Hills, Arizona, USA (R. Hunkler)

Main Article

Table 2

Input values used to estimate influenza antiviral drug–related reduction in hospitalizations during pandemic (H1N1) 2009 outbreak in the United States, April 24, 2009–March 26, 2010

Input Initial value Sources
Distribution of prescriptions by patient age group, y* IMS Health Xponent database (3)
0–17 38.6%
18–64 53.4%
>65
 5.3%
Prescriptions filled for prophylaxis† 10% Assumption: Some prescriptions were written to prevent infection and disease without presentation of symptoms.
Prescriptions for patients who failed to adhere to drug regimen or used for personal stockpiles
 20%
 Assumption: Not all patients will adhere with the drug regimen as prescribed. Also, some prescriptions were for personal stockpiles
Antiviral drug effectiveness against hospitalization, by age group, y‡ Literature review (see Table 3)
0–17 22%–32%
18–64 34%–50%
>65
 30%–50%
Median (range) risk for hospitalization, given pandemic (H1N1) 2009–related illness, by age group, y§ Reed et al. (4)
0–17 0.0038 (0.00314–0.00428)
18–64 0.00496 (0.0041–0.00558)
>65 0.0155 (0.0128–0.0174)

*Age group–based distribution of prescriptions based on IMS (IMS Health, Norwalk, CT, USA) that covered prescriptions written for oseltamivir (only) from October 9, 2009, through March 26, 2010.
†These inputs were subjected to sensitivity analyses (see Table 4).
‡Effectiveness estimate assumes that the patient follows the drug regimen, i.e., these estimates do not allow for those who do not take the complete course. Failure to follow prescribed drug regimen was assumed to have 0% effect on reducing risk of hospitalization. This assumption was accounted for in a separate input.
§Risk of per-person hospitalization, given symptomatic illness caused by pandemic (H1N1) 2009 virus.

Main Article

References
  1. Shrestha  SS, Swerdlow  DL, Borse  RH, Prabhu  VS, Finelli  L, Atkins  CY. Estimating the burden of 2009 pandemic influenza A (H1N1) in the United States (April 2009–April 2010). Clin Infect Dis. 2011;52(Suppl 1):S75–82. DOIPubMedGoogle Scholar
  2. Centers for Disease Control and Prevention. Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009–2010 season [cited 2010 Dec 18]. http://www.cdc.gov/H1N1flu/recommendations.htm#d
  3. Health  IMS. Data Assets, IMS Prescription Data [cited 2010 Dec 18]. http://www.imshealth.com/portal/site/imshealth/menuitem.a46c6d4df3db4b3d88f611019418c22a/?vgnextoid=a4284c30aaaa0210VgnVCM100000ed152ca2RCRD&vgnextchannel=bc42650204850210VgnVCM100000ed152ca2RCRD&vgnextfmt=default
  4. Reed  C, Angulo  FJ, Swerdlow  DL, Lipsitch  M, Meltzer  MI, Jernigan  D. Estimates of the prevalence of pandemic (H1N1) 2009, United States, April–July 2009. Emerg Infect Dis. 2009;15:2004–7. DOIPubMedGoogle Scholar
  5. Strong  M, Burrows  J, Stedman  E, Redgrave  P. Adverse drug effects following oseltamivir mass treatment and prophylaxis in a school outbreak of 2009 pandemic influenza A(H1N1) in June 2009, Sheffield, United Kingdom. Euro Surveill 2010;15:pii:19565.
  6. Kitching  A, Roche  A, Balasegaram  S, Heathcock  R, Maguire  H. Oseltamivir adherence and side effects among children in three London schools affected by influenza A(H1N1)v, May 2009—an internet-based cross-sectional survey. Euro Surveill. 2009;14:pii:19287.
  7. Kaiser  L, Wat  C, Mills  T, Mahoney  P, Ward  P, Hayden  F. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med. 2003;163:1667–72. DOIPubMedGoogle Scholar
  8. Blumentals  WA, Schulman  KL. Impact of oseltamivir on the incidence of secondary complications of influenza in adolescent and adult patients: results from a retrospective population-based study. Curr Med Res Opin. 2007;23:2961–70. DOIPubMedGoogle Scholar
  9. Gums  JG, Pelletier  EM, Blumentals  WA. Oseltamivir and influenza-related complications, hospitalization and healthcare expenditure in healthy adults and children. Expert Opin Pharmacother. 2008;9:151–61. DOIPubMedGoogle Scholar
  10. Orzeck  EA, Shi  N, Blumentals  WA. Oseltamivir and the risk of influenza-related complications and hospitalizations in patients with diabetes. Clin Ther. 2007;29:2246–55. DOIPubMedGoogle Scholar
  11. Peters  PH, Moscona  A, Schulman  KL, Barr  CE. Study of the impact of oseltamivir on the risk for pneumonia and other outcomes of influenza, 2000–2005. Medscape J Med. 2008;10:131.PubMedGoogle Scholar
  12. Mäkelä  MJ, Pauksens  K, Rostila  T, Fleming  DM, Man  CY, Keene  ON. Clinical efficacy and safety of the orally inhaled neuraminidase inhibitor zanamivir in the treatment of influenza: a randomized, double-blind, placebo-controlled European study. J Infect. 2000;40:42–8. DOIPubMedGoogle Scholar
  13. Hayden  FG, Sperber  SJ, Belshe  RB, Clover  RD, Hay  AJ, Pyke  S. Recovery of drug-resistant influenza A virus during therapeutic use of rimantadine. Antimicrob Agents Chemother. 1991;35:1741–7.PubMedGoogle Scholar
  14. The  MIST. (Management of Influenza in the Southern Hemisphere Trialists) Study Group. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. Lancet. 1998;352:1877–81.PubMedGoogle Scholar
  15. Aoki  FY, Macleod  MD, Paggiaro  P, Carewicz  O, Sawy  AE, Wat  C. Early administration of oral oseltamivir increases the benefits of influenza treatment. J Antimicrob Chemother. 2003;51:123–9. DOIPubMedGoogle Scholar
  16. Hayden  FG, Osterhaus  AD, Treanor  JJ, Fleming  DM, Aoki  FY, Nicholson  KG. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenzavirus infections. GG167 Influenza Study Group. N Engl J Med. 1997;337:874–80. DOIPubMedGoogle Scholar
  17. Lalezari  J, Campion  K, Keene  O, Silagy  C. Zanamivir for the treatment of influenza A and B infection in high-risk patients: a pooled analysis of randomized controlled trials. Arch Intern Med. 2001;161:212–7. DOIPubMedGoogle Scholar
  18. Monto  AS, Moult  AB, Sharp  SJ. Effect of zanamivir on duration and resolution of influenza symptoms. Clin Ther. 2000;22:1294–305. DOIPubMedGoogle Scholar
  19. Nicholson  KG, Aoki  FY, Osterhaus  AD, Trottier  S, Carewicz  O, Mercier  CH. Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial. Neuraminidase Inhibitor Flu Treatment Investigator Group. Lancet. 2000;355:1845–50. DOIPubMedGoogle Scholar
  20. Treanor  JJ, Hayden  FG, Vrooman  PS, Barbarash  R, Bettis  R, Riff  D. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. US Oral Neuraminidase Study Group. JAMA. 2000;283:1016–24. DOIPubMedGoogle Scholar
  21. Whitley  RJ, Hayden  FG, Reisinger  KS, Young  N, Dutkowski  R, Ipe  D. Oral oseltamivir treatment of influenza in children. Pediatr Infect Dis J. 2001;20:127–33. DOIPubMedGoogle Scholar
  22. Prosser  LA, Meltzer  MI, Fiore  A, Epperson  S, Bridges  CB, Hinrichsen  V. Effects of adverse events of the projected population benefits and cost-effectiveness of using live attenuated influenza vaccine in children aged 6 months to 4 years. Arch Pediatr Adolesc Med. 2011;165:112–8. DOIPubMedGoogle Scholar
  23. Beigi  RH, Wiringa  AE, Bailey  RR, Assi  T-M, Lee  BY. Economic value of seasonal and pandemic influenza during pregnancy. Clin Infect Dis. 2009;49:1784–92. DOIPubMedGoogle Scholar
  24. Fairbrother  G, Cassedy  A, Ortega-Sanchez  IR, Szilagyi  PG, Edwards  KM, Molinari  N-A. High costs of infleunza: direct medical costs of influenza disease in young children. Vaccine. 2010;28:4913–9. DOIPubMedGoogle Scholar
  25. Keren  R, Zaoutis  TE, Saddlemire  S, Luan  XQ, Coffin  SE. Direct medical costs of influenza-related hospitalizations in children. Pediatrics. 2007;119:227.
  26. Cox  FM, Cobb  MM, Chua  WQ, McLaughlin  TP, Okamoto  LJ. Cost of treating influenza in emergency department and hospital settings. Am J Manag Care. 2000;6:205–14.PubMedGoogle Scholar

Main Article

Page created: June 19, 2012
Page updated: June 19, 2012
Page reviewed: June 19, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external