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. 2023 Dec 1;152(6):e2023061960.
doi: 10.1542/peds.2023-061960.

Trends in Outpatient Influenza Antiviral Use Among Children and Adolescents in the United States

James W Antoon  1 , Jyotirmoy Sarker  2 , Abdullah Abdelaziz  2 , Pei-Wen Lien  2 , Derek J Williams  1 , Todd A Lee  2 , Carlos G Grijalva  3
Affiliations

Trends in Outpatient Influenza Antiviral Use Among Children and Adolescents in the United States

James W Antoon et al. Pediatrics. .

Abstract

Background: Influenza antivirals improve outcomes in children with duration of symptoms <2 days and those at high risk for influenza complications. Real-world prescribing of influenza antivirals in the pediatric population is unknown.

Methods: We performed a cross-sectional study of outpatient and emergency department prescription claims in individuals <18 years of age included in the IBM Marketscan Commercial Claims and Encounters Database between July 1, 2010 and June 30, 2019. Influenza antiviral use was defined as any dispensing of oseltamivir, baloxavir, or zanamivir. The primary outcome was the rate of antiviral dispensing per 1000 enrolled children. Secondary outcomes included antiviral dispensing per 1000 influenza diagnoses and inflation-adjusted costs of antiviral agents. Outcomes were calculated and stratified by age, acute versus prophylactic treatment, influenza season, and geographic region.

Results: The analysis included 1 416 764 unique antiviral dispensings between 2010 and 2019. Oseltamivir was the most frequently prescribed antiviral (99.8%). Dispensing rates ranged from 4.4 to 48.6 per 1000 enrolled children. Treatment rates were highest among older children (12-17 years of age), during the 2017 to 2018 influenza season, and in the East South Central region. Guideline-concordant antiviral use among young children (<2 years of age) at a high risk of influenza complications was low (<40%). The inflation-adjusted cost for prescriptions was $208 458 979, and the median cost ranged from $111 to $151.

Conclusions: There is wide variability and underuse associated with influenza antiviral use in children. These findings reveal opportunities for improvement in the prevention and treatment of influenza in children.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Dr Grijalva has received consulting fees from Merck. Dr Williams has received in-kind research support from Biomerieux. The other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Relationship between antiviral dispensing rates and influenza diagnoses. The solid line represents antiviral dispensings per 1000 enrolled children over 10 calendar years. The dotted line represents the influenza diagnoses from the ILINet over the same calendar year. Influenza diagnoses are plotted as a percentage of influenza diagnoses.
FIGURE 2
FIGURE 2
Rate of influenza treatment and prophylaxis by age. Box and whisker plot revealing differences in (A) treatment and (B) prophylactic dispensing rates by age. The bottom and top boxes denote 25th and 75th percentiles, respectively (IQR). The diamond within each box represents the median; the line within each box denotes means.
FIGURE 3
FIGURE 3
Geographic variation in influenza antiviral use. Rates of influenza antiviral use per 1000 enrolled children by US Census Division during the 2018 to 2019 influenza season. The number within each region denotes the median weighted percentage of visits for ILI for the region as reported by the ILINet for the 2018 to 2019 influenza season.
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