Cost-effectiveness analysis of hospital infection control response to an epidemic respiratory virus threat

DOI: 10.3201/eid1512.090902
Suggested citation for this article: Dan YY, Tambyah PA, Sim J, Lim J, Hsu LY, Chow WL, et al. Cost-effectiveness analysis of hospital infection control response to an epidemic respiratory virus threat. Emerg Infect Dis. 2009 Dec; [Epub ahead of print]
Cost-effectiveness Analysis of Hospital Infection Control Response to an Epidemic Respiratory Virus Threat

Yock Young Dan, Paul A. Tambyah, Joe Sim, Jeremy Lim, Li Yang Hsu, Wai Leng Chow, Dale A. Fisher, Yue Sie Wong, and Khek Yu Ho
Author affiliations: National University Health System, Singapore (Y.Y. Dan, P.A. Tambyah, J. Sim, L.Y. Hsu, D.A. Fisher, K.Y. Ho); and Singapore General Hospital, Singapore (J. Lim, W.L. Chow, Y.S. Wong)

The outbreak of influenza A pandemic (H1N1) 2009 prompted many countries in Asia, previously strongly affected by severe acute respiratory syndrome (SARS), to respond with stringent measures, particularly in preventing outbreaks in hospitals. We studied actual direct costs and cost-effectiveness of different response measures from a hospital perspective in tertiary hospitals in Singapore by simulating outbreaks of SARS, pandemic (H1N1) 2009, and 1918 Spanish influenza. Protection measures targeting only infected patients yielded lowest incremental cost/death averted of $23,000 (US$) for pandemic (H1N1) 2009. Enforced protection in high-risk areas (Yellow Alert) and full protection throughout the hospital (Orange Alert) averted deaths but came at an incremental cost of up to $2.5 million/death averted. SARS and Spanish influenza favored more stringent measures. High case-fatality rates, virulence, and high proportion of atypical manifestations impacted cost-effectiveness the most. A calibrated approach in accordance with viral characteristics and community risks may help refine responses to future epidemics.

Pandemic influenza A (H1N1) 2009 virus is a new influenza virus of swine origin that was first detected in April 2009. Within 4 months of its appearance in Mexico, it had spread to >100 countries, with >200,000 confirmed cases globally, including >2,000 deaths (1). When the World Health Organization (WHO) raised its global influenza pandemic alert to phase 5 (imminent pandemic) on April 27, 2009, many countries followed suit and activated their pandemic preparedness plans, although this varied between countries. Many countries with direct...

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