Estimating the United States demand for influenza antivirals and the effect on severe influenza disease during a potential pandemic

Abstract

Following the detection of a novel influenza strain A(H7N9), we modeled the use of antiviral treatment in the United States to mitigate severe disease across a range of hypothetical pandemic scenarios. Our outcomes were total demand for antiviral (neuraminidase inhibitor) treatment and the number of hospitalizations and deaths averted. The model included estimates of attack rate, healthcare-seeking behavior, prescription rates, adherence, disease severity, and the potential effect of antivirals on the risks of hospitalization and death. Based on these inputs, the total antiviral regimens estimated to be available in the United States (as of April 2013) were sufficient to meet treatment needs for the scenarios considered. However, distribution logistics were not examined and should be addressed in future work. Treatment was estimated to avert many severe outcomes (5200-248,000 deaths; 4800-504,000 hospitalizations); however, large numbers remained (25,000-425,000 deaths; 580,000-3,700,000 hospitalizations), suggesting that the impact of combinations of interventions should be examined.

Keywords: antivirals; death; hospitalization; influenza; neuraminidase inhibitors.