Evaluating the Value of Over-the-Counter Oseltamivir for Influenza: A Cost-Utility Analysis From U.S. Payer and Societal Perspectives
Author(s)
Olivia Yip, PharmD, Kyu Lee, MS, PhD;
University of Washington, Seattle, WA, USA
University of Washington, Seattle, WA, USA
Presentation Documents
OBJECTIVES: Influenza places a substantial burden on the U.S. healthcare system. Oseltamivir, an antiviral medication for influenza, is being considered for over the counter (OTC) status to improve patient access without requiring a prescription. While this proposal raises concerns about potential misuse and antiviral resistance, advancements in rapid testing could enable the safe and effective OTC dispensing of oseltamivir.
METHODS: A decision-tree model was developed to compare 1-year outcomes under two scenarios: (1) OTC availability of oseltamivir following a positive rapid test and (2) prescription-only access. Key outcomes included total direct and indirect costs, quality-adjusted life years (QALYs), sick days avoided, and incremental cost-effectiveness ratios (ICERs) calculated using a $150,000 per QALY willingness-to-pay threshold. Analyses were conducted for three populations: healthy adults, adults aged 65 and older, and individuals at high risk of complications. This study evaluated the cost-effectiveness of OTC oseltamivir from U.S. payer and societal perspectives.
RESULTS: For healthy adults, OTC oseltamivir resulted in direct costs of $82.19 and 0.9576 QALYs, compared to $76.40 and 0.9575 QALYs under prescription-only access. Among older adults, reclassification was associated with costs of $87.96 and 0.9557 QALYs versus $79.93 and 0.9553 QALYs. For high-risk adults, OTC availability led to costs of $87.96 and 0.9560 QALYs, compared to $79.93 and 0.9557 QALYs with prescription-only access. The incremental cost-effectiveness ratios (ICERs) were $57,004 per QALY gained for healthy adults, $20,369 per QALY gained for older adults, and $25,570 per QALY gained for high-risk adults. From a societal perspective, OTC oseltamivir resulted in lower costs and higher QALYs across all populations, making it a dominant strategy.
CONCLUSIONS: Reclassifying oseltamivir as an OTC medication is a cost-effective strategy from both payer and societal perspectives, supporting improved access and broader public health benefits.
METHODS: A decision-tree model was developed to compare 1-year outcomes under two scenarios: (1) OTC availability of oseltamivir following a positive rapid test and (2) prescription-only access. Key outcomes included total direct and indirect costs, quality-adjusted life years (QALYs), sick days avoided, and incremental cost-effectiveness ratios (ICERs) calculated using a $150,000 per QALY willingness-to-pay threshold. Analyses were conducted for three populations: healthy adults, adults aged 65 and older, and individuals at high risk of complications. This study evaluated the cost-effectiveness of OTC oseltamivir from U.S. payer and societal perspectives.
RESULTS: For healthy adults, OTC oseltamivir resulted in direct costs of $82.19 and 0.9576 QALYs, compared to $76.40 and 0.9575 QALYs under prescription-only access. Among older adults, reclassification was associated with costs of $87.96 and 0.9557 QALYs versus $79.93 and 0.9553 QALYs. For high-risk adults, OTC availability led to costs of $87.96 and 0.9560 QALYs, compared to $79.93 and 0.9557 QALYs with prescription-only access. The incremental cost-effectiveness ratios (ICERs) were $57,004 per QALY gained for healthy adults, $20,369 per QALY gained for older adults, and $25,570 per QALY gained for high-risk adults. From a societal perspective, OTC oseltamivir resulted in lower costs and higher QALYs across all populations, making it a dominant strategy.
CONCLUSIONS: Reclassifying oseltamivir as an OTC medication is a cost-effective strategy from both payer and societal perspectives, supporting improved access and broader public health benefits.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE292
Topic
Economic Evaluation
Topic Subcategory
Work & Home Productivity - Indirect Costs
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine)