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.
NOTES TO EDITOR:
1. A copy of the embargoed article, "Influenza Strategies in Older Adults" is available by calling 800-523-1546, ext. 2656 or 215-351-2656.
2. Dr. Rothberg is available for interview by calling Chad Mullin, Baystate Medical Center public relations department, at 413-794-7629.
3. This article is the subject of a video news release produced by the American College of Physicians Internal Medicine Report series. The VNR will be released on Monday, Sept. 1. Call for co-ordinates.
Journal
Annals of Internal Medicine