Cost-effectiveness of Pharmaceutical-based Pandemic Influenza Mitigation Strategies

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Volume 16, Number 2–February 2010
Research
Cost-effectiveness of Pharmaceutical-based Pandemic Influenza Mitigation Strategies1
Anthony T. Newall, James G. Wood, Noemie Oudin, and C. Raina MacIntyre
Author affiliations: University of New South Wales, Sydney, New South Wales, Australia (A.T. Newall, J.G. Wood, C.R. MacIntyre); and National Institute for Applied Sciences, Lyon, France (N. Oudin)

Suggested citation for this article

Abstract
We used a hybrid transmission and economic model to evaluate the relative merits of stockpiling antiviral drugs and vaccine for pandemic influenza mitigation. In the absence of any intervention, our base-case assumptions generated a population clinical attack rate of 31.1%. For at least some parameter values, population prepandemic vaccination strategies were effective at containing an outbreak of pandemic influenza until the arrival of a matched vaccine. Because of the uncertain nature of many parameters, we used a probabilistic approach to determine the most cost-effective strategies. At a willingness to pay of >A$24,000 per life-year saved, more than half the simulations showed that a prepandemic vaccination program combined with antiviral treatment was cost-effective in Australia.

Influenza pandemics of varying severity occurred 3 times in the last century (1918, 1957, and 1968); the first influenza pandemic of the 21st century occurred in 2009. Before this latest pandemic, awareness had been heightened by the emergence of the highly pathogenic (H5N1) strain (1). In response, many countries have developed detailed plans aimed at the mitigation of a future pandemic. A key aspect of many pandemic plans is the stockpiling of antiviral drugs (neuraminidase inhibitors) for treatment or prophylaxis (2,3).

The stockpiling of prepandemic vaccine is also an area of active consideration (4). Although a matched vaccine (developed specifically for the emergent strain) is likely to offer the best protection, the delay in producing such a vaccine is a major obstacle. The stockpiling of prepandemic vaccine based on currently available strains avoids this delay but such vaccine is likely to provide lower efficacy than a matched vaccine. There is also a substantial risk that the pandemic strain will be of a different subtype than that chosen for the stockpiled vaccine. The emergence of pandemic (H1N1) 2009 illustrates this point.

Mathematical models of disease transmission have been used to assess the feasibility of pandemic mitigation strategies (5–10). However, of the limited numbers of published economic evaluations on pandemic stockpiling (11–14), to our knowledge only 1 recent study has attempted to directly model herd protection (14). We explored the cost-effectiveness of stockpiling prepandemic vaccine and antiviral drugs for pandemic influenza mitigation.

Suggested Citation for this Article
Newall AT, Wood JG, Oudin N, MacIntyre CR. Cost-effectiveness of pharmaceutical-based pandemic influenza mitigation strategies. Emerg Infect Dis [serial on the Internet]. 2010 Feb [date cited]. http://www.cdc.gov/EID/content/16/2/224.htm

DOI: 10.3201/eid1602.090571


1This material was compiled before the declaration of pandemic (H1N1) 2009 and concerns stockpiling for a future influenza pandemic.



abrir aquí para acceder al documento CDC EID completo del cual se reproduce un 5%:
http://www.cdc.gov/eid/content/16/2/224.htm