this
article almost convinced me that Tamiflu should be taken
prophylactically and not be spared for treatment in a pandemic wave.
Agreed ?
Good luck having some of that when TSHTF.
You will not have enough Tamifly for prophylaxis. Period.
Assume a family of four. Assume 3 “waves”, each lasting 15 days. You will require about 200 doses at the prophylactic dose for “seasonal flu”. If you go by some thinking, double that for potential panflu. 400 doses. Of course add 8 capsules for each and every day in the “wave”.
For treatment, assume the same family 3/4 get ill and take Tamiflu at double the usual seasonal dose and for doupble the duration (i.e. 4 capsules daily x 10 days). In this scenario you require 120 doses (about 1/4).
Remember, Tamiflu is in limited supply, and is quite expensive. Assuming you have an Rx for it, and you pay cash for it, those 400 capsules (assuming you can procure it) will cost you close to 2 G’s.
I can’t follow your calculation. For your assumed “3 waves of 15 days”
you would need 45 capsules or 4.5 packets of Tamiflu per actually
$60, so $260 in total for prophylaxis.
For your supposed treatment you would need 4 packages.
Now, suppose you have 1 package of Tamiflu, 10*75mg ,
and considering the graphics of the quoted article,
would you spare that package for poptential treatment
or should you take it prophylactically on days, where you are at
risk contacting the virus ?
Seems to me that prophylactic use is better in any case,
no matter how much Tamiflu you’ve got.
found these:
Post-exposure influenza prophylaxis with oseltamivir: cost effectiveness and cost utility in families in the UK.
Sander B, Hayden FG, Gyldmark M, Garrison LP Jr.
Division of Clinical Decision-Making and Health Care Research, University Health Network, Toronto, Ontario, Canada.
OBJECTIVES: To assess the cost effectiveness and cost utility of preventing post-exposure influenza infection using the neuraminidase inhibitor oseltamivir from a healthcare payer’s perspective in the UK. METHODS: A simulation model was developed, based on clinical trial results and published data, to predict morbidity and mortality due to influenza and to compare oseltamivir post-exposure prophylaxis (PEP) with no prophylaxis within families with members aged >or=13 years. Two scenarios were tested:1. Comparison of patients receiving PEP versus patients not receiving PEP and not being treated with oseltamivir should they become infected. 2. Comparison of patients receiving PEP versus patients not receiving PEP but being treated with oseltamivir should they become infected. The model was run with an attack rate in household contacts of 8% for the base case, with higher rates (up to 30%, representing pandemic conditions) tested in sensitivity analyses. A societal perspective and other key parameters were tested in sensitivity analysis. The year of costing was 2002. The time span for the model was up to 1 year (including one influenza season), but loss of life was included in the QALY calculation and based on expected life expectancy. RESULTS: PEP with oseltamivir results in reduced morbidity (i.e. fewer influenza cases) and associated reductions in complications, hospitalisations and mortality due to influenza. When comparing oseltamivir PEP with no prophylaxis for contact attack rates of 8%, 12% and 30%, the mean costs per QALY gained for scenario one were estimated at 29,938 pounds, 18,697 pounds and 5403 pounds, respectively; the mean costs per case avoided were 467 pounds, 293 pounds and 84 pounds, respectively. The corresponding results for scenario two were 52,202 pounds, 31,610 pounds and 9688 pounds per QALY gained. CONCLUSIONS: PEP with oseltamivir is likely to be a cost-effective strategy for family contacts in the UK from a healthcare payer perspective when influenza-like illness contact attack rates are 8% or higher and the only treatment given is ‘usual care’.
PMID: 16605283 [PubMed - indexed for MEDLINE]
Antivirals for influenza in healthy adults: systematic review. Jefferson T, Demicheli V, Rivetti D, Jones M, Di Pietrantonj C, Rivetti A. Cochrane Vaccines Field, ASL 20, 15100 Alessandria, Italy. Toj1@aol.com
BACKGROUND: Use of antivirals is recommended for the control of seasonal and pandemic influenza. Our aim was to review the evidence of efficacy, effectiveness, and safety of registered antivirals against naturally occurring influenza in healthy adults. METHODS: We searched various Databases to October, 2005, and contacted manufacturers and corresponding authors. We included randomised controlled trials comparing prophylactic (n=27) or treatment (n=27) efficacy against symptomatic or asymptomatic influenza. We did a meta-analysis and expressed prophylactic efficacy as a proportion (1-relative risk [RR]). For treatment trials, because of inconsistent and non-standardised reporting, we expressed continuous outcomes either as means or as hazard ratios. FINDINGS: We included 51 reports of 52 randomised controlled trials. Amantadine prevented 61% (95% CI 35–76) of influenza A cases and 25% (13–36) of cases of influenza-like illness, but caused nausea (OR 2.56, 1.37–4.79), insomnia and hallucinations (2.54, 1.50–4.31), and withdrawals because of adverse events (2.54, 1.60–4.06). There was no effect on asymptomatic cases (RR 0.85, 0.40–1.80). In treatment, amantadine significantly shortened duration of fever compared with placebo (by 0.99 days, −1.26 to −0.71), but had no effect on nasal shedding of influenza A viruses (0.93, 0.71–1.21). The fewer data for rimantadine showed comparable effects. In prophylaxis, compared with placebo, neuraminidase inhibitors have no effect against influenza-like illness (1.28, 0.45–3.66 for oral oseltamivir 75 mg daily, 1.51, 0.77–2.95 for inhaled zanamivir 10 mg daily). Higher doses appear to make no difference. The efficacy of oral oseltamivir 75 mg daily against symptomatic influenza is 61% (15–82), or 73% (33–89) at 150 mg daily. Inhaled zanamivir 10 mg daily is 62% efficacious (15–83). Neither neuraminidase inhibitor appeared effective against asymptomatic influenza. Oseltamivir induces nausea (OR 1.79, 1.10–2.93), especially at higher prophylactic doses (2.29, 1.34–3.92). Oseltamivir in a post-exposure prophylaxis role has a protective efficacy of 58.5% (15.6–79.6) for households and from 68% (34.9–84.2) to 89% (67–97) in contacts of index cases. In influenza cases, compared with placebo the hazard ratios for time to alleviation of symptoms were 1.33, 1.29–1.37 for zanamivir; 1.30, 1.13–1.50 for oseltamivir provided medication was started within 48 h of symptom onset. Viral nasal titres were significantly diminished by both drugs (weighted mean difference −0.62, −0.82 to −0.41). Oseltamivir at 150 mg daily was effective in preventing lower respiratory tract complications in influenza cases (OR 0.32, 0.18–0.57). We could find no credible data on the effects of oseltamivir on avian influenza. INTERPRETATION: The use of amantadine and rimantadine should be discouraged. Because of their low effectiveness, neuraminidase inhibitors should not be used in seasonal influenza control and should only be used in a serious epidemic or pandemic alongside other public-health measures.
PMID: 16443037 [PubMed - indexed for MEDLINE]
seems that you should take Tamiflu as soon as you had contact with infected people (“PEP”) and not wait until you have symptoms. Right ?
What is shelf life of tamiflu? I just got some and package says one year? Is that right?
murphy – at 13:13 --- Where did you get it? Most of the packages I’ve seen show between 3 and 5 years for the expy dates…
What is the reason for the shortage of Tamiflu?- if it’s hand’s on deck then why can’t we just all volunteer.
Blue. Excellent point!!
*Touchdown*
bump
Anyone know where they are in the development of Relenza in an easy to administer form?
Tamiflu as a prophylaxis would be great if we could stay on it until a good vaccine is readily available. Tamiflu resistence would probably develop before then. The protection will only work as long as we have it too take.
Why was our government so late in ordering it and why haven’t countries spent million’s or more to find better ways to increase production? This does not make sense to me.
Well- I think they figure only 1–2 % of the population is going to die…
A short answer to all these “why are we not buying more tamiflu” questions is that there is a worldwide shortage. Production capacity has been increased, and they are looking at being able to clear back-orders by the end of the year. But that’s just for orders placed like last year. Good luck with new orders now!
Also go here for dilemmas with using tamiflu for prophylaxis. The rest of that thread also deals with other ramifications of treatment, efficacy, etc.
Closed to maintain Forum speed.