Would school closure for the 2009 H1N1 influenza epidemic have been worth the cost?: a computational simulation of Pennsylvania

Abstract

BackgroundDuring the 2009 H1N1 influenza epidemic, policy makers debated over whether, when, and how long to close schools. While closing schools could have reduced influenza transmission thereby preventing cases, deaths, and health care costs, it may also have incurred substantial costs from increased childcare needs and lost productivity by teachers and other school employees.MethodsA combination of agent-based and Monte Carlo economic simulation modeling was used to determine the cost-benefit of closing schools (vs. not closing schools) for different durations (range: 1 to 8 weeks) and symptomatic case incidence triggers (range: 1 to 30) for the state of Pennsylvania during the 2009 H1N1 epidemic. Different scenarios varied the basic reproductive rate (R0) from 1.2, 1.6, to 2.0 and used case-hospitalization and case-fatality rates from the 2009 epidemic. Additional analyses determined the cost per influenza case averted of implementing school closure.ResultsFor all scenarios explored, closing schools resulted in substantially higher net costs than not closing schools. For R0 = 1.2, 1.6, and 2.0 epidemics, closing schools for 8 weeks would have resulted in median net costs of $21.0 billion (95% Range: $8.0 - $45.3 billion). The median cost per influenza case averted would have been $14,185 ($5,423 - $30,565) for R0 = 1.2, $25,253 ($9,501 - $53,461) for R0 = 1.6, and $23,483 ($8,870 - $50,926) for R0 = 2.0.ConclusionsOur study suggests that closing schools during the 2009 H1N1 epidemic could have resulted in substantial costs to society as the potential costs of lost productivity and childcare could have far outweighed the cost savings in preventing influenza cases.

A systems approach to obesity

“…A similar lag can be seen in other areas of health and public health, but systems approaches have made some inroads in infectious disease prevention and control, helping decision makers understand the spread of infectious diseases in a given location, the consequences of infectious disease, and the potential impact of various control measures. [37][38][39][40][41][42][43][44] What are the reasons for the lag in systems approaches to obesity? One reason may be that obesity, until recently, has been viewed as more of an individual patient problem rather than a broader public health problem.…”

The influence of school holiday timing on epidemic impact

“…There are serious disadvantages to closing schools as a precautionary measure, including inconvenience, knock-on economic impacts caused by parental absenteeism from work, and alternative childcare costs [7,11,15,26]. Furthermore, the usefulness of closing schools to prevent an epidemic from taking off is questionable: if school closure could only be feasibly continued for a short period of time its result -unless a mass vaccination campaign could be carried out during the period of closure -would be to delay an epidemic rather than to prevent it.…”

“…Numerous infectious disease outbreaks take place in schools, and it is expected that schools would feature heavily in any new epidemic of influenza and similar illnesses [1,[4][5][6]. Therefore school closure has been considered as a possibility during an outbreak [7][8][9][10][11][12][13][14][15][16][17][18][19]. There are a number of reasons why school closure might take place, including staff illness, high levels of pupil absence, parental concern, or as an intervention to attempt to slow the spread of infection.…”

The cost of an Ebola case

“…For example, our previous influenza work during the H1N1 pandemic has provided information that is useful to decision makers since the pandemic. [14][15][16][17][18][19][20][21] Thirdly, during the Ebola outbreak, other diseases do not cease their activity. Therefore, one may want to compare the impact of Ebola versus other currently active diseases to help make choices, even after the current outbreak subsides.…”