Study of the impact of oseltamivir on the risk for pneumonia and other outcomes of influenza, 2000-2005

Abstract

Context: Influenza results in large numbers of secondary complications and hospitalizations.

Objective: To assess the impact of oseltamivir on influenza-related complications and hospitalizations by analyzing health insurance claims data for 6 influenza seasons.

Design: A retrospective cohort study utilizing claims data from the 2000-2005 influenza seasons.

Setting: Claims data were obtained from Thomson Healthcare MarketScan Research Databases.

Patients: Patients prescribed oseltamivir within 1 day of influenza diagnosis were compared to those prescribed no antiviral therapy (controls).

Outcomes: Frequencies of pneumonia, other respiratory illnesses, and otitis media, and rates of hospitalization, were compared for the oseltamivir and no antiviral groups. Expenditure was also analyzed. Relative risk (RR) for each outcome was assessed using Cox proportional hazards regression.

Results: Overall, 31,674 patients received oseltamivir and were propensity matched to patients with no antiviral prescription. Oseltamivir reduced the risk of diagnosis of pneumonia by 15% (RR 0.85, 95% confidence interval [CI] 0.73, 0.98), other respiratory illnesses by 20% (RR 0.80, 95% CI: 0.76, 0.83), and otitis media and its complications by 31% (RR 0.69, 95% CI: 0.61, 0.79). The greatest reductions in pneumonia risk, of 57% and 52%, were observed for children aged 6-12 years (RR 0.43, 95% CI: 0.26, 0.71) and 1-2 years (RR 0.48, 95% CI: 0.24, 0.99), respectively. Overall, hospitalization rates were reduced by 38% (RR 0.62, 95% CI: 0.52, 0.74) in the oseltamivir group compared with the no antiviral group. Total adjusted expenditures in the oseltamivir and no antiviral groups were not significantly different.

Conclusions: Oseltamivir reduced the relative risk of influenza-related complications and hospitalization when prescribed immediately upon presentation of influenza.

Figure 1

Patient disposition for clinical outcomes and healthcare expenditures, and safety analyses.

Figure 2

Adjusted relative risks for the diagnosis of selected illness within 14 days of diagnosis of influenza in patients receiving oseltamivir vs patients who received no antiviral therapy – overall population.* *Primary diagnoses for respiratory illness were categorized as follows: acute respiratory infections, other disease of the upper respiratory tract, COPD, and allied conditions, pneumoconiosis and related lung diseases, other diseases of the respiratory system, all respiratory diagnoses. Diagnoses of otitis media and its complications were categorized as follows: eustachian salpingitis, mastoiditis, myringitis, and any otitis media or complication.

Figure 3

Adjusted relative risks for diagnosis of pneumonia, respiratory illnesses, and otitis media and its complications in patients receiving oseltamivir vs patients who received no antiviral therapy, by age group.* *Primary diagnoses for respiratory illness were categorized as follows: acute respiratory infections, other disease of the upper respiratory tract, chronic obstructive pulmonary disorder COPD, and allied conditions, pneumoconiosis and related lung diseases, other diseases of the respiratory system, all respiratory diagnoses. Diagnoses of otitis media and its complications were categorized as follows: eustachian salpingitis, mastoiditis, myringitis, and any otitis media or complication.

Figure 4

Adjusted relative risks for hospitalization for pneumonia, respiratory illnesses, and/or any reason in patients receiving oseltamivir vs patients who received no antiviral therapy, by age group.* *Primary diagnoses for respiratory illness were categorized as follows: acute respiratory infections, other disease of the upper respiratory tract, chronic obstructive pulmonary disorder COPD, and allied conditions, pneumoconiosis and related lung diseases, other diseases of the respiratory system, all respiratory diagnoses. Diagnoses of otitis media and its complications were categorized as follows: eustachian salpingitis, mastoiditis, myringitis, and any otitis media or complication.