The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis

Abstract

BackgroundThe impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning.MethodsA cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ∼30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR), using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR.ResultsIntervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS) for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5%) the cost is ∼$9 k per LYS; for a low severity pandemic (CFR of 0.1%) this strategy costs ∼$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03%) the cost is ∼$155 per LYS. With high severity pandemics (CFR >0.75%) the most effective attack rate reduction strategies are also the most cost effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death.ConclusionsThe most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in reducing the infection rate.

Symbolic transfer entropy reveals the age structure of pandemic influenza transmission from high-volume influenza-like illness data

“…Then, we use an EMR-based dataset capturing ILI incidence from 884 ZIP ( postal) codes and 12 age classes across the USA to rank the relative importance of the various age groups in the transmission of the autumn wave of the 2009 A/H1N1pdm influenza pandemic in that country. We conclude that school-aged children (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) year-olds) were disproportionately responsible for transmitting influenza to infants through working-age adults in the autumn of 2009, in broad agreement with other findings. Our work demonstrates that STE could serve as an important tool for the detailed epidemiological analysis of age structure, especially as EMR data become more prevalent.…”

“…STE is positively associated with reporting rates, which can partially confound estimates of asymmetric transmission. STE estimates from ILI time-series data from July-December 2009 in the USA suggest that the transmission of the autumn wave of the A/H1N1pdm pandemic influenza outbreak was likely dominated by [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] year-olds. It is unlikely that this result can be explained by differences in reporting rates alone.…”

The Effect of School Closure on Hand, Foot, and Mouth Disease Transmission in Singapore: A Modeling Approach

“…21,22 Analyses also suggest that school closure combined with the use of antiviral agents is cost-effective and is a justifiable strategy for mitigating influenza pandemics. 23,24 There is, however, a lack of empirical evidence on the effect of school closure on HFMD transmission: one exception is a review of HFMD in Hong Kong that revealed fewer HFMD consultations than expected during the 2003 severe acute respiratory syndrome and the 2009 influenza pandemic, which was attributed to various control measures including school closure. 25,26 This article aimed to assess the effect of school closure on HFMD transmission.…”

The impact of hand, foot and mouth disease control policies in Singapore: A qualitative analysis of public perceptions

“…10,14 Yet, analysis suggests school closures are deemed cost-effective and justifiable only in response to highseverity epidemics. [15][16][17] The effectiveness of school closures as a social distancing measure was dependent on socio-economic and geographic contexts, 11,18,19 single versus multi-wave epidemics, 20 and compliance with limiting social interaction during school closures. 11,17,19 Indirect evidence for the effect of school closure on HFMD comes from Hong Kong, where closures during SARS (2003) and pandemic influenza (2009) led to fewer consultations for HFMD than expected based on the preceding years.…”