Key Message

What Is the Issue?

• Influenza is a major public health concern, causing significant illness, death, economic challenges, and pandemic potential. This underscores the need for effective prevention (also known as prophylaxis), treatment, and pandemic preparedness strategies.
• Antiviral medications such as baloxavir marboxil, oseltamivir, peramivir, zanamivir are recommended for the treatment of influenza; however, their economic value remains unclear.

What Did We Do?

• We conducted a rapid review to identify and summarize evidence on the cost-effectiveness of antivirals for preventing and treating influenza A, influenza B, and zoonotic influenza, as well as the cost-effectiveness of antiviral stockpiling.
• We searched electronic databases and key online sources for economic evaluation studies published in English from January 1, 2019, to December 13, 2024. Additionally, we examined the cost-effectiveness of stockpiling from studies published from January 1, 2020, to April 4, 2025.
• One researcher screened citations, selected studies, and narratively summarized the study findings.

What Did We Find?

• We identified 9 economic evaluations: 8 examining the treatment of influenza and 1 examining both post-exposure prophylaxis and treatment.
• We did not identify any studies on the cost-effectiveness of antivirals for the prophylaxis or treatment of zoonotic influenza or any studies that evaluated the cost-effectiveness of stockpiling antiviral drugs.
• Economic studies suggest that certain antivirals may be cost-effective for treating influenza compared to standard of care, particularly in high-risk populations. However, it is unclear how cost-effective antivirals are for post-exposure prophylaxis, as there is limited evidence from just 1 study.

What Does It Mean?

• Economic evaluations suggest that oseltamivir or baloxavir marboxil are cost-effective treatments for influenza, particularly in high-risk populations.
• Baloxavir marboxil may be a valuable alternative in cases of oseltamivir resistance to ensure optimal resource allocation and long-term sustainability of antiviral treatments. However, its higher cost requires careful consideration.
• The generalizability of existing economic evaluations may be limited due to variability in influenza strains, health care systems, and cost structures that differ from Canada.
   

Key Message

What is the Issue?

• Conventional central line insertion technique using the landmark method (LM) to identify the target vein for catheter insertion does not account for potential anatomical variations at the insertion site.
• LM is associated with a high risk of mechanical complications. An x-ray exam is often required to confirm correct placement to minimize complications.
• Point-of-care ultrasound (POCUS) for central venous catheter (CVC) guidance has become a routine method in emergency medicine for identifying the vein location and providing real-time guidance for insertion.
• Chest x-ray represents the gold standard for verification of tip position after the catheter has been inserted. While using POCUS to guide CVC insertion removes the need for x-ray to confirm correct placement, an x-ray is still commonly ordered after CVC placement in the intensive care unit (ICU) and emergency department (ED) settings.
• As the use of POCUS-guided CVC insertion continues to expand in clinical practice, its clinical effectiveness compared with LM technique remains unclear.

What Did We Do?

• To support decision-making, we conducted a rapid review to identify and summarize current studies and evidence-based guidelines that compared the clinical effectiveness of POCUS to landmark methods for CVC insertion. This report is an update to a previous report published in 2023.

What Did We Find?

• Current evidence suggests that the use of POCUS to guide the insertion of CVC placement is effective compared with the landmark method.
• POCUS-guided CVC resulted in a significantly lower rate of complications for pneumo- or hemothorax, arterial puncture, and hematoma compared to LM when the internal jugular vein was targeted (0.9% versus 5.2%). Insertion at the femoral or subclavian veins resulted in variable findings.
• POCUS-guided central venous catheter insertion had a significantly higher correct placement rate compared to the conventional landmarking method (92% versus 75%).
• All 4 evidence-based guidelines provided recommendations for the use of POCUS-guided CVC insertion in emergency medicine, critical care, and acute care settings, although the strength of the recommendation varied depending on the targeted central vein.
• POCUS may offer advantages over x-ray when confirming CVC placement and screening for complications, although it may be less readily available than x-ray in some settings.

Key Message

What Is the Issue?

• Antiviral medications for influenza can be used after exposure but before symptom onset to reduce the occurrence of symptomatic and asymptomatic influenza.
• There are several different antiviral medications available for preventing influenza after exposure (also known as post-exposure prophylaxis). It is important to understand their overall and comparative efficacy for treatment and stockpiling decisions.

What Did We Do?

• We conducted a rapid review of the recent evidence on the clinical efficacy and safety of different antiviral medications available in Canada for post-exposure prophylaxis.
• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2020.

What Did We Find?

• We identified 2 systematic reviews (SRs) of 12 randomized studies published in 2024. The included studies examined the efficacy of 3 antiviral medications (baloxavir, oseltamivir, and zanamivir) in preventing influenza infection. The reviews were generally well conducted.
• The findings show that these 3 antiviral medications are effective in reducing symptomatic influenza infection; however, the evidence on their impact on overall influenza and asymptomatic influenza infections is less clear.
• The evidence on the impact of these medicines on hospitalization and mortality was generally weak, with no strong conclusions. There is also little evidence of any additional adverse events (side effects) from these medicines.
• We found no evidence on peramivir for any of the outcomes.

What Does It Mean?

• The included studies support the efficacy and safety of 3 antiviral medications in post-exposure settings for influenza prevention. More evidence is needed to understand their impact on hospitalization and mortality.