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

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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.

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