BACKGROUND AND OBJECTIVE: Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; however, oseltamivir is not frequently prescribed to ILI patients in the primary-care setting. An open-label, multi-country, multi-season, randomised controlled trial investigated the effectiveness of oseltamivir for treating ILI in 15 European countries. We aimed to evaluate whether patients presenting with ILI in primary care and being managed with the addition of oseltamivir to usual care had lower average direct and indirect costs compared to patients with usual care alone. METHODS: Resource use data were extracted from participants' daily diaries. Itemised country-specific unit costs were collected through official tariffs, pharmacies or literature. Costs were converted to 2018 values. The null hypothesis was tested based on one-sided credible intervals (CrIs) obtained by bootstrapping. Base-case analysis estimated direct cost and productivity losses using itemised costed resource use and the human capital approach. Scenario analyses with self-reported spending rather than itemised costing were also performed. RESULTS: Patients receiving oseltamivir (N = 1306) reported fewer healthcare visits, medication uses, hospital attendances and paid-work hours lost than the other patients (N = 1298). Excluding the oseltamivir cost, the average direct costs were lower in patients treated with oseltamivir from all perspectives, but these differences were not statistically significant (perspective of patient: €17 [0-95% Crl: 16-19] vs. €24 [5-100% Crl: 18-29]; healthcare provider: €37 [28-67] vs. €44 [25-55]; healthcare payers: €54 [45-85] vs. €68 [45-81]; and society: €423 [399-478] vs. €451 [390-478]). Scenario and age-group analyses confirmed these findings, but with some between-country differences. CONCLUSION: The average direct and indirect costs were consistently lower in patients treated with oseltamivir than in patients without from four perspectives (excluding the oseltamivir cost). However, these differences were not statistically significant.

1st Faculty of Medicine Institute of General Practice Charles University Prague Prague Czech Republic

Antibiotic Center for Primary Care Department of General Practice Institute of Health and Society University of Oslo Oslo Norway

Centre for Health Economics Research and Modelling Infectious Diseases Vaccine and Infectious Disease Institute University of Antwerp Universiteitsplein 1 2610 Wilrijk Belgium

Département de Santé Publique Centre Hospitalier Universitaire de Nice Université Côte d'Azur Nice France

Department of Clinical Research Basel Institute for Clinical Epidemiology and Biostatistics University Hospital Basel Basel Switzerland

Department of Family Medicine and Population Health Laboratory of Medical Microbiology University of Antwerp Antwerp Belgium

DRC Drug Research Center LLC Balatonfüred Hungary

Drug Study Unit Institut Universitari d'Investigació en Atenció Primària Jordi Gol Barcelona Spain

Family Doctors' Clinic Lodz Poland

FDC Mano šeimos gydytojas Klaipeda Lithuania

Interuniversity Institute for Biostatistics and statistical Bioinformatics Hasselt University Hasselt Belgium

Julius Center for Health Sciences and Primary Care University Medical Center Utrecht The Netherlands

Malia Surgery Kastelli HC Heraklio Greece

Primary Health Care School of Public Health and Community Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

Research and Development Primary Health Care Region Västra Götaland Research and Development Centre Södra Älvsborg Borås Sweden

School of Primary Care Population Sciences and Medical Education Faculty of Medicine University of Southampton Southampton UK

Section and Research Unit of General Practice Department of Public Health University of Copenhagen Copenhagen Denmark

The Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK

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