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Treating Older Adults for Flu Is Cost-Effective But Preventing It Is Better

PHILADELPHIA -- (September 2, 2003) A new study finds that treating older adults who have the flu with one of two available classes of drugs is cost-effective. Treating younger adults with anti-flu drugs is cost-effective because it cuts lost work time, but until now it was not known if the treatment would be cost-effective for older adults. The study is published in the September 1, 2003, issue of Annals of Internal Medicine.

Using published information and computer models, the researchers compared the outcomes and costs of a variety of strategies for caring for older adults with flu-like illness, including no testing or treatment, testing for flu before treatment with a newer or an older anti-flu drug, and treating without testing.

For patients older than 65 who had not been vaccinated or who were at high risk for complications, using a newer anti-flu drug without first testing for flu was cost-effective. For vaccinated or low-risk patients, rapid testing followed by the newer drug if the test is positive appeared to be the best strategy.

Newer anti-flu drugs cost significantly more than older antiviral therapy but combat both influenza A and influenza B. The older, less expensive anti-flu drugs, which combat only influenza A, are a reasonable alternative if patients cannot afford the higher-cost drugs.

Lead study author Michael B. Rothberg, MD, MPH, an internist at Baystate Medical Center in Springfield, Mass., said the results show that, despite their costs, anti-flu drugs are a reasonable strategy for treating older patients with flu symptoms, "But the best advice for older adults is to get a flu shot every year because vaccination decreases the probability of getting the flu and reduces the severity of illness." According to Dr. Rothberg, vaccination decreases the need for hospitalization by one-third and reduces mortality by half.

Influenza occurs in yearly epidemics and can have serious consequences for older adults, especially those with heart or lung disease. Flu kills about 36,000 people each year in the United States, most of them over 65, and sends more than 100,000 people to hospitals. The U.S. Advisory Committee on Immunization Practices estimates that fewer than two-thirds of people over 65 get yearly vaccination against influenza, even though the vaccine is recommended for all adults over 50 and for younger people at high risk for complications of flu.

"Doctors are often hesitant to prescribe anti-flu drugs because they're expensive and won't work if the patient has a virus other than influenza," says Rothberg. "But for people over age 65, influenza is so dangerous that treatment with antiviral drugs is very cost-effective, even when the doctor isn't sure of the diagnosis." Rothberg cautions that anti-flu treatment only works if started within the first 48 hours after symptoms appear.

Source: American College of Physicians

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