Developments in influenza prevention and treatment - A managed care perspective

Until recently, control of influenza has focused on increasing the use of t he inactivated influenza vaccine and, in some countries, encouraging the ap propriate use of the antiviral drugs amantadine and rimantadine. Now that a new class of antiviral drugs, the neuraminidase inhibitors, has been appro ved for use in many countries, and a live attenuated vaccine is on the hori zon, novel opportunities have arisen for the prevention and treatment of in fluenza. The clinical effectiveness of these innovations has not been fully determined in many patient populations, particularly in managed-care envir onments; clinical and economic impacts are similarly considered in making d ecisions regarding access to new technologies in most healthcare delivery s ystems. However, it is possible to use available information to speculate o n how these technologies might he used, while the relative clinical and cos t consequences of these innovations are further clarified. In treatment, the neuraminidase inhibitors have been shown to significantly reduce the duration of influenza-related illness and usage of antibacteria l drugs. As the clinical benefits and cost effectiveness of new drugs are d ocumented, utilisation of these agents is likely to extend from those with underlying risk conditions to previously healthy individuals. For preventio n, the new live attenuated vaccines will be increasingly used in children. Inactivated vaccines will continue to be used mainly fur the elderly and ad ults with underlying health conditions. There will also be a limited role f or the antiviral drugs in prophylaxis seasonally, but more extensive use is likely in families and in the workplace for short periods after exposure. Relative differences in clinical effectiveness, patient preference and cost will inform managed-care organisations on whether to promote or restrict t he use of these interventions in various patient populations.