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Interdisciplinary pharmacometrics linking oseltamivir pharmacology, influenza epidemiology and health economics to inform antiviral use in pandemics
- Source :
- British Journal of Clinical Pharmacology. 83:1580-1594
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
Abstract
- Aims A modular interdisciplinary platform was developed to investigate the economic impact of oseltamivir treatment by dosage regimen under simulated influenza pandemic scenarios. Methods The pharmacology module consisted of a pharmacokinetic distribution of oseltamivir carboxylate daily area under the concentration–time curve at steady state (simulated for 75 mg and 150 mg twice daily regimens for 5 days) and a pharmacodynamic distribution of viral shedding duration obtained from phase II influenza inoculation data. The epidemiological module comprised a susceptible, exposed, infected, recovered (SEIR) model to which drug effect on the basic reproductive number (R0), a measure of transmissibility, was linked by reduction of viral shedding duration. The number of infected patients per population of 100 000 susceptible individuals was simulated for a series of pandemic scenarios, varying oseltamivir dose, R0 (1.9 vs. 2.7), and drug uptake (25%, 50%, and 80%). The number of infected patients for each scenario was entered into the health economics module, a decision analytic model populated with branch probabilities, disease utility, costs of hospitalized patients developing complications, and case-fatality rates. Change in quality-adjusted life years was determined relative to base case. Results Oseltamivir 75 mg relative to no treatment reduced the median number of infected patients, increased change in quality-adjusted life years by deaths averted, and was cost-saving under all scenarios; 150 mg relative to 75 mg was not cost effective in low transmissibility scenarios but was cost saving in high transmissibility scenarios. Conclusion This methodological study demonstrates proof of concept that the disciplines of pharmacology, disease epidemiology and health economics can be linked in a single quantitative framework.
- Subjects :
- 0301 basic medicine
Pharmacology
medicine.medical_specialty
Oseltamivir
education.field_of_study
Health economics
business.industry
030106 microbiology
Population
Pharmacometrics
03 medical and health sciences
Regimen
chemistry.chemical_compound
0302 clinical medicine
chemistry
Epidemiology
Pandemic
medicine
Pharmacology (medical)
030212 general & internal medicine
Intensive care medicine
business
education
Basic reproduction number
Subjects
Details
- ISSN :
- 03065251
- Volume :
- 83
- Database :
- OpenAIRE
- Journal :
- British Journal of Clinical Pharmacology
- Accession number :
- edsair.doi...........3aff16c78509adda51abf9b986d817fe