Oseltamivir use in adolescents and adults: clinical and economic considerations

Influenza remains an important cause of morbidity and mortality, and incurs substantial economic costs (mainly due to hospitalisation) especially for the elderly aged 65 years or more, and among those with high-risk medical conditions. Influenza vaccination is the most effective control measure for both healthy populations and the chronically ill in whom complications of influenza cluster. Unfortunately, vaccination is less effective in the elderly and immunocompromised persons. Additional benefit may accrue from other health care interventions including antiviral therapy. Oseltamivir, a neuraminidase inhibitor, has become a drug of public health importance since it was included in influenza pandemic management plans. Many systematic reviews and meta-analyses of oseltamivir treatment and prophylaxis trials have been published. We provide a summary of the conclusions and review the various findings of economic analyses. Future randomised controlled trials should focus upon costly outcomes such as hospital admissions and should be conducted in populations at high risk of complications from influenza. Future economic analyses need to address variation in (1) willing-to-pay value, (2) annual attack rate of influenza, and (3) influenza vaccination effectiveness and uptake rates.