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To test or to treat? an analysis of influenza testing and Antiviral treatment strategies using economic computer modeling

Lee, BY and McGlone, SM and Bailey, RR and Wiringa, AE and Zimmer, SM and Smith, KJ and Zimmerman, RK (2010) To test or to treat? an analysis of influenza testing and Antiviral treatment strategies using economic computer modeling. PLoS ONE, 5 (6).

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Background: Due to the unpredictable burden of pandemic influenza, the best strategy to manage testing, such as rapid or polymerase chain reaction (PCR), and antiviral medications for patients who present with influenza-like illness (ILI) is unknown. Methodology/Principal Findings: We developed a set of computer simulation models to evaluate the potential economic value of seven strategies under seasonal and pandemic influenza conditions: (1) using clinical judgment alone to guide antiviral use, (2) using PCR to determine whether to initiate antivirals, (3) using a rapid (point-of-care) test to determine antiviral use, (4) using a combination of a point-of-care test and clinical judgment, (5) using clinical judgment and confirming the diagnosis with PCR testing, (6) treating all with antivirals, and (7) not treating anyone with antivirals. For healthy younger adults (<65 years old) presenting with ILI in a seasonal influenza scenario, strategies were only cost-effective from the societal perspective. Clinical judgment, followed by PCR and point-of-care testing, was found to be cost-effective given a high influenza probability. Doubling hospitalization risk and mortality (representing either higher risk individuals or more virulent strains) made using clinical judgment to guide antiviral decision-making cost-effective, as well as PCR testing, point-of-care testing, and point-of-care testing used in conjunction with clinical judgment. For older adults (≥65 years old), in both seasonal and pandemic influenza scenarios, employing PCR was the most cost-effective option, with the closest competitor being clinical judgment (when judgment accuracy ≥50%). Point-of-care testing plus clinical judgment was cost-effective with higher probabilities of influenza. Treating all symptomatic ILI patients with antivirals was cost-effective only in older adults. Conclusions/Significance: Our study delineated the conditions under which different testing and antiviral strategies may be cost-effective, showing the importance of accuracy, as seen with PCR or highly sensitive clinical judgment. © 2010 Lee et al.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Lee, BYbyl1@pitt.eduBYL1
McGlone, SM
Bailey, RR
Wiringa, AEaew29@pitt.eduAEW29
Zimmer, SMzimmersm@pitt.eduZIMMERSM
Smith, KJkjs8@pitt.eduKJS8
Zimmerman, RKzimmer@pitt.eduZIMMER0000-0001-5941-6092
ContributionContributors NameEmailPitt UsernameORCID
Date: 11 August 2010
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 5
Number: 6
DOI or Unique Handle: 10.1371/journal.pone.0011284
Schools and Programs: School of Public Health > Epidemiology
School of Medicine > Biomedical Informatics
Refereed: Yes
MeSH Headings: Antiviral Agents--therapeutic use; Computer Simulation; Humans; Influenza, Human--diagnosis; Influenza, Human--drug therapy; Influenza, Human--epidemiology; Influenza, Human--mortality; Models, Economic; Point-of-Care Systems; Polymerase Chain Reaction
Other ID: NLM PMC2890406
PubMed Central ID: PMC2890406
PubMed ID: 20585642
Date Deposited: 03 Aug 2012 20:58
Last Modified: 30 Jan 2024 22:55


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