Cost-effectiveness of oseltamivir treatment for children with uncomplicated seasonal influenza.

OBJECTIVE To evaluate the cost-effectiveness of oseltamivir treatment for seasonal influenza in children and consider the impact of oseltamivir resistance on these findings. STUDY DESIGN We developed a model to evaluate 1-year clinical and economic outcomes associated with 3 outpatient management strategies for unvaccinated children with influenza-like-illness: no antiviral treatment; diagnostic testing and oseltamivir treatment when positive; and empiric oseltamivir treatment. The model depicted a hypothetical non-pandemic influenza season with a 29% level of oseltamivir resistance in circulating viruses, and 14% to 54% probability of seasonal influenza with influenza-like-illness. Strategies were compared with incremental cost-effectiveness ratios. RESULTS In our primary analysis, empiric oseltamivir treatment consistently produced the greatest benefit. The incremental cost-effectiveness of this alternative, compared with testing and treating, was <$100,000 per quality-adjusted life year gained in all age groups except the oldest. The testing strategy was consistently more effective compared with no treatment and cost between $25,900 and $71,200 per quality-adjusted life year gained, depending on age. Results were sensitive to the prevalence of oseltamivir resistance in circulating viruses. CONCLUSION Empiric oseltamivir treatment of seasonal influenza is associated with favorable cost-effectiveness ratios, particularly in children aged 1 to <12 years, but ratios are highly dependent on the prevalence of oseltamivir resistance among circulating influenza viruses.