We assessed the relationship between individual characteristics and receipt of oseltamivir (Tamiflu) in the United States during the H1N1 pandemic and other flu seasons.

Cover: Equity in the Receipt of Oseltamivir in the United States During the H1N1 Pandemic

Equity in the Receipt of Oseltamivir in the United States During the H1N1 Pandemic

Published In: American Journal of Public Health, v. 104, no. 6, June 2014, p. 1052-1058

Posted on RAND.org on June 01, 2014

by Jessica M. Franklin, Niteesh K. Choudhry, Lori Uscher-Pines, Gregory Brill, Olga S. Matlin, Michael A. Fischer, Sebastian Schneeweiss, Jerry Avorn, Troyen A. Brennan, William H. Shrank

Research Question

  1. Was receipt of oseltamivir (Tamiflu) during the H1N1 pandemic equitable?

OBJECTIVE: We assessed the relationship between individual characteristics and receipt of oseltamivir (Tamiflu) in the United States during the H1N1 pandemic and other flu seasons. METHODS: In a cohort of individuals enrolled in pharmacy benefit plans, we used a multivariate logistic regression model to measure associations between subscriber characteristics and filling a prescription for oseltamivir during 3 flu seasons (October 2006–May 2007, October 2007–May 2008, and October 2008–May 2010). In 19 states with county-level influenza rates reported, we controlled for disease burden. RESULTS: Approximately 56 million subscribers throughout the United States were included in 1 or more study periods. During pandemic flu, beneficiaries in the highest income category had 97% greater odds of receiving oseltamivir than those in the lowest category (P < .001). After we controlled for disease burden, subscribers in the 2 highest income categories had 2.18 and 1.72 times the odds of receiving oseltamivir compared with those in the lowest category (P < .001 for both). CONCLUSIONS: Income was a stronger predictor of oseltamivir receipt than prevalence of influenza. These findings corroborate concerns about equity of treatment in pandemics, and they call for improved approaches to distributing potentially life-saving treatments.

Key Findings

  • Individuals with higher incomes were more likely to receive oseltamivir (Tamiflu) in the U.S. during the H1N1 pandemic and in other flu seasons.
  • These findings raise concerns about equity of treatment during future pandemics.
Access further information on this document at American Public Health Association

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.