Management of influenza symptoms in healthy children: cost-effectiveness of rapid testing and antiviral therapy.

OBJECTIVE To determine the cost-effectiveness of rapid testing and antiviral therapy for children of different ages with symptoms of influenza. DESIGN Cost-effectiveness analysis from the societal perspective using a decision model based on published data. SETTING Physician's office during an influenza A epidemic. PARTICIPANTS Hypothetical children aged 2, 7, and 15 years. INTERVENTIONS Rapid testing or clinical diagnosis followed by treatment with amantadine hydrochloride or oseltamivir phosphate compared with no antiviral therapy. OUTCOME MEASURES Costs and quality-adjusted life expectancy. RESULTS Empirical therapy with antiviral medication resulted in the greatest quality-adjusted life expectancy in all age groups. Compared with not treating, antiviral therapy improved quality-adjusted life expectancy by 0.003 quality-adjusted life-year by shortening the duration of illness and preventing otitis media. In young children it saved up to USD 121 per child mostly by avoiding parental work loss. Excluding work loss, antiviral therapy improved quality-adjusted life expectancy at a cost of USD 800 to 1800 per quality-adjusted life-year saved. Compared with amantadine, oseltamivir was not cost-effective when influenza A predominated. The incremental cost-effectiveness of oseltamivir fell below USD 50 000 per quality-adjusted life-year saved when the proportion of influenza B exceeded 14% for a 2-year-old, 27% for a 7-year-old, or 43% for a 15-year-old. Rapid testing was cost-effective only when the probability of influenza was 60% or less. CONCLUSIONS For children presenting with influenza symptoms during a local influenza outbreak, treatment with antiviral therapy appears to offer the best outcome and often saves money. The choice of antiviral drug should be based on the prevalence of influenza B.