Treating Kids During Flu Outbreak Cost-effective

NEW YORK (Reuters Health) - During outbreaks of influenza A, treating children with the antiviral drug amantadine is likely to be a cost-effective measure if treatment begins within 48 hours of symptom onset, especially if it allows quicker return to school and parents' return to work, investigators report. For influenza B, oseltamivir is more effective than amantadine.

However, rapid testing is usually not a cost-effective option, primarily because of its lack of sensitivity.

Oseltamivir (Tamiflu) and amantadine (Symmetrel, Endantadine) are the only two antivirals currently licensed for treatment of influenza in children younger than 7 years. Whether the benefits of therapy outweigh the costs and potential adverse effects remains an open question.

Dr. Michael B. Rothberg and colleagues at Tufts University School of Medicine in Boston used a decision analytic model to assess the cost-effectiveness of the treatment choices when otherwise healthy children ages 2, 7 and 15 years of age develop symptoms of influenza. The researchers report their findings in the Archives of Pediatric and Adolescent Medicine.

Compared with no drug treatment, therapy improved quality-adjusted life expectancy in all of the age groups by shortening the length of illness and preventing ear infections, Rothberg's team reports.

When influenza A was the predominant infection "amantadine therapy was the least expensive strategy in children younger than 15 years, because the savings from parents returning to work sooner far exceeded the cost of the medication," saving $121 per child, they note. Even for older children, the cost of treatment is relatively low.

Oseltamivir, although equally effective for influenza A, cost more and had more adverse effects than amantadine.

The authors recommend oseltamivir if influenza B is common because amantadine is not effective for this strain. State departments of health or online information from the Centers for Disease Control and Prevention can advise doctors which strain of influenza predominates in their area.

The authors find that rapid testing is useful only when the probability of influenza is less than 50 percent, especially during influenza B outbreaks, because oseltamivir is expensive relative to the cost of testing, and sensitivity is less important when the pretest probability is low.

SOURCE: Archives of Pediatric and Adolescent Medicine, November 2005.