Oseltamivir Treatment for Children with Influenza-Like Illness in China: A Cost-Effectiveness Analysis

BackgroundInfluenza is a common viral respiratory infection that causes epidemics and pandemics in the human population. Oseltamivir is a neuraminidase inhibitor—a new class of antiviral therapy for influenza. Although its efficacy and safety have been established, there is uncertainty regarding whether influenza-like illness (ILI) in children is best managed by oseltamivir at the onset of illness, and its cost-effectiveness in children has not been studied in China.ObjectiveTo evaluate the cost-effectiveness of post rapid influenza diagnostic test (RIDT) treatment with oseltamivir and empiric treatment with oseltamivir comparing with no antiviral therapy against influenza for children with ILI.MethodsWe developed a decision-analytic model based on previously published evidence to simulate and evaluate 1-year potential clinical and economic outcomes associated with three managing strategies for children presenting with symptoms of influenza. Model inputs were derived from literature and expert opinion of clinical practice and research in China. Outcome measures included costs and quality-adjusted life year (QALY). All the interventions were compared with incremental cost-effectiveness ratios (ICER).ResultsIn base case analysis, empiric treatment with oseltamivir consistently produced the greatest gains in QALY. When compared with no antiviral therapy, the empiric treatment with oseltamivir strategy is very cost effective with an ICER of RMB 4,438. When compared with the post RIDT treatment with oseltamivir, the empiric treatment with oseltamivir strategy is dominant. Probabilistic sensitivity analysis projected that there is a 100% probability that empiric oseltamivir treatment would be considered as a very cost-effective strategy compared to the no antiviral therapy, according to the WHO recommendations for cost-effectiveness thresholds. The same was concluded with 99% probability for empiric oseltamivir treatment being a very cost-effective strategy compared to the post RIDT treatment with oseltamivir.ConclusionIn the Chinese setting of current health system, our modelling based simulation analysis suggests that empiric treatment with oseltamivir to be a cost-saving and very cost-effective strategy in managing children with ILI.     

Nitrogen removal in moving bed sequencing batch reactor using polyurethane foam cubes of various sizes as carrier materials

The performance of moving bed sequencing batch reactors (MBSBRs) added with 8 % (v/v) of polyurethane (PU) foam cubes as carrier media in nitrogen removal was investigated in treating low COD/N wastewater. The results indicate that MBSBR with 8-mL cubes achieved the highest total nitrogen (TN) removal efficiency of 37% during the aeration period, followed by 31%, 24% and 19 % for MBSBRs with 27-, 64- and 125-mL cubes, respectively. The increased TN removal in MBSBRs was mainly due to simultaneous nitrification and denitrification (SND) process which was verified by batch studies. The relatively lower TN removal in MBSBR with larger PU foam cubes was attributed to the observation that larger PU foam cubes were not fully attached by biomass. Higher concentrations of 8-mL PU foam cubes in batch reactors yielded higher TN removal.     

Bioregeneration of granular activated carbon in simultaneous adsorption and biodegradation of chlorophenols

The objectives of this study are to obtain the time courses of the amount of chlorophenol adsorbed onto granular activated carbon (GAC) in the simultaneous adsorption and biodegradation processes involving 4-chlorophenol (4-CP) and 2,4-dichlorophenol (2,4-DCP), respectively, and to quantify the bioregeneration efficiency of GAC loaded with 4-CP and 2,4-DCP by direct measurement of the amount of chlorophenol adsorbed onto GAC. Under abiotic and biotic conditions, the time courses of the amount of chlorophenol adsorbed onto GAC at various GAC dosages for the initial 4-CP and 2,4-DCP concentrations below and above the biomass acclimated concentrations of 300 and 150 mg/L, respectively, were determined. The results show that the highest bioregeneration efficiency was achieved provided that the initial adsorbate concentration was lower than the acclimated concentration. When the initial adsorbate concentration was higher than the acclimated concentration, the highest bioregeneration efficiency was achieved if excess adsorbent was used.