Estimating Effect of Antiviral Drug Use during Pandemic (H1N1) 2009 Outbreak, United States

Charisma Y. Atkins, Anita Patel, Thomas H. Taylor, Jr., Matthew Biggerstaff, Toby L. Merlin, Stephanie M. Dulin, Benjamin A. Erickson, Rebekah H. Borse, Robert Hunkler, and Martin I. Meltzer

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.Y. Atkins, A. Patel, T.H. Taylor, Jr., M. Biggerstaff, T.L. Merlin, S.M. Dulin, B.A. Erikson, R.H. Borse, M.I. Meltzer); and IMS Health, Fountain Hills, Arizona, USA (R. Hunkler)
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Abstract
From April 2009 through March 2010, during the pandemic (H1N1) 2009 outbreak, ≈8.2 million prescriptions for influenza neuraminidase-inhibiting antiviral drugs were filled in the United States. We estimated the number of hospitalizations likely averted due to use of these antiviral medications. After adjusting for prescriptions that were used for prophylaxis and personal stockpiles, as well as for patients who did not complete their drug regimen, we estimated the filled prescriptions prevented ≈8,400–12,600 hospitalizations (on the basis of median values). Approximately 60% of these prevented hospitalizations were among adults 18–64 years of age, with the remainder almost equally divided between children 0–17 years of age and adults >65 years of age. Public health officials should consider these estimates an indication of success of treating patients during the 2009 pandemic and a warning of the need for renewed planning to cope with the next pandemic.

From April 23, 2009, through April 10, 2010, it is estimated that pandemic (H1N1) 2009 virus caused ≈61 million cases of influenza (range 43–89 million cases), ≈270,000 related hospitalizations (range 195,000–403,000 hospitalizations), and ≈12,500 deaths (range 8,900–18,300 deaths) in the United States (1). Even before the impact was fully known, the Centers for Disease Control and Prevention (CDC) recommended prompt empiric treatment with influenza antiviral drugs, principally the neuraminidase-inhibiting influenza antiviral drugs oseltamivir and zanamivir, of persons with suspected or confirmed influenza and who also met >1 of the following conditions: 1) illness that required hospitalization; 2) progressive, severe, or complicated illness, regardless of previous health status; and 3) risk for severe disease (e.g., patients with asthma, neurologic and neurodevelopmental conditions; chronic lung or heart disease; blood, endocrine, kidney, liver, and metabolic disorders; pregnancy; and those who were old or young) (2). The primary goal of these recommendations was to reduce the number and severity of pandemic (H1N1) 2009 cases, especially hospitalizations.
We present estimates of the number of pandemic (H1N1) 2009–related hospitalizations, by age group, averted because of use of antiviral drugs given to treat clinical cases of influenza. These results can be used by public health policy makers to plan and prepare for the next pandemic. For example, these estimates can be used to help evaluate the policy option of replenishing state and federal influenza antiviral drug stockpiles
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