Mitigation of pandemic influenza: review of cost-effectiveness studies

We conducted a review of economic evaluations of pandemic influenza control measures. In the studies found, we detected various interventions being investigated: antiviral stockpiling and treatment, prophylaxis, vaccination, school closure and restricting international travel. Cost-effectiveness varied but often showed potentials for the favorable economic profiles of these measures. Both static and dynamic models were used. We conclude that the choice of an appropriate model - in particular, a dynamic model - is crucial to arrive at valid cost-effectiveness ratios. Yet, of the economic evaluations considered here, only a few were based on dynamic modeling. We recommend that further research is directed toward linking dynamic epidemiological models for pandemic spread with economic outcomes by considering the full impacts on national economies, including direct, indirect, medical and nonmedical costs

Investment decisions in influenza pandemic contingency planning: cost-effectiveness of stockpiling antiviral drugs

Background: The threat of an influenza pandemic has led to stockpiling of antiviral drugs in order to mitigate a plausible outbreak. If the stockpile would be used in relation to the recent pandemic alert, an investment decision about renewing the stock for a possible subsequent pandemic is essential. The decision should include cost-effectiveness considerations. Methods: We constructed a cost-effectiveness analysis in the Dutch context, explicitly including risk of an outbreak. Outcomes from a dynamic transmission model, comparing an intervention with a non-intervention scenario, were input in our health economic calculations. Results: Stockpiling was cost-effective from the health-care perspective if the actual risk is 37% for 30 years. If less than 60% of the population would take the antiviral drugs or the attack rate is about 50%, the investment would not be cost-effective from this perspective. Conclusion: Risk perception, realistic coverage among population and size of a pandemic are crucial parameters and highly decisive for the investment decision

Investment in antiviral drugs: A real options approach

Real options analysis is a promising approach to model investment under uncertainty. We employ this approach to value stockpiling of antiviral drugs as a precautionary measure against a possible influenza pandemic. Modifications of the real options approach to include risk attitude and deviations from expected utility are presented. We show that risk aversion counteracts the tendency to delay investment for this case of precautionary investment, which is in contrast to earlier applications of risk aversion to real options analysis. Moreover, we provide a numerical example using real world data and discuss the implications of real options analysis for health policy. Suggestions for further extensions of the model and a comparison with the expected value of information analysis are put forward. Copyright (C) 2009 John Wiley & Sons, Ltd

Optimal Allocation of Pandemic Influenza Vaccine Depends on Age, Risk and Timing

The limited production capacity for vaccines raises the question what the best strategy is for allocating the vaccine to mitigate an influenza pandemic. We developed an age-structured model for spread of an influenza pandemic and validated it against observations from the Asian flu pandemic. Two strategies were evaluated: vaccination can be implemented at the start of the influenza pandemic, or vaccination will be implemented near the peak of it. Our results suggest prioritizing individuals with a high-risk of complications if a vaccine becomes available during a pandemic. If available at the start, vaccinating school children might be considered since this results in slightly lower expected number of deaths

Economic Costs of Measles Outbreak in the Netherlands, 2013-2014

Contains fulltext : 152151.pdf (publisher's version ) (Open Access)In 2013 and 2014, the Netherlands experienced a measles outbreak in orthodox Protestant communities with low measles-mumps-rubella vaccination coverage. Assessing total outbreak costs is needed for public health outbreak preparedness and control. Total costs of this outbreak were an estimated $4.7 million

Cost effectiveness of vaccination against pandemic influenza in European countries: mathematical modelling analysis

Objective To investigate whether a single optimal vaccination strategy exists across countries to deal with a future influenza pandemic by comparing the cost effectiveness of different strategies in various pandemic scenarios for three European countries. Design Economic and epidemic modelling study. Settings General populations in Germany, the Netherlands, and the United Kingdom. Data sources Country specific patterns of social contact and demographic data. Model An age structured susceptible-exposed-infected-recovered transmission model that describes how an influenza A virus will spread in the populations of Germany, the Netherlands, and the United Kingdom. Interventions Comparison of four vaccination strategies: no vaccination, blanket vaccination, vaccination of elderly people (>= 65 years), and vaccination of high transmitters (5-19 years). The four strategies were evaluated for scenarios in which a vaccine became available early or at the peak of the pandemic, and in which either everyone was initially susceptible or older age groups had pre-existing immunity. Main outcome measure Cost per quality adjusted life years (QALYs) gained. Results All vaccination strategies were cost effective (incremental cost per QALY gained, comparing intervention with non-intervention). In scenarios where the vaccine became available at the peak of the pandemic and there was pre-existing immunity among elderly people the incremental cost effectiveness ratios for vaccinating high transmitters were (sic)7325 (5815; pound $10 470) per QALY gained for Germany, (sic)10 216 per QALY gained for the Netherlands, and (sic)7280 per QALY gained for the United Kingdom. The most cost effective strategy not only differed across the pandemic scenarios but also between countries. Specifically, when the vaccine was available early in the pandemic and there was no pre-existing immunity, in Germany it would be most cost effective to vaccinate elderly people ((sic)940 per QALY gained), whereas it would be most cost effective to vaccinate high transmitters in both the Netherlands ((sic)525 per QALY gained) and the United Kingdom ((sic)163 per QALY gained). This difference in optimal strategies was due to differences in the demographic characteristics of the countries: Germany has a significantly higher proportion of elderly people compared with the Netherlands and the United Kingdom. Conclusions No single vaccination strategy was most cost effective across countries. With aging populations, pre-existing immunity in particular could be of crucial importance for the cost effectiveness of options to mitigate a future influenza pandemic

Pertussis.

In 2012, a large pertussis epidemic occurred with the highest number of notified cases since the introduction of notifications in 1976. Data on GP consultations and hospitalisations from 2012 also showed an increase. In the first six months of 2013 the incidence of pertussis notifications was found to be low. B. pertussis continues to change in ways that suggest adaptation to vaccination. The most recent change involves the emergence of strains which do not produce one or more components of pertussis vaccines. The Dutch Health Council will recommend possible additional preventive measures. The main focus of pertussis vaccination is to prevent severe pertussis in young, not yet fully vaccinated, infants. Pertussis outbreaks continue to be reported throughout the world. Maternal immunisation is recommended in several countries to better protect young, not yet fully vaccinated, infants. (aut.ref.

The burden of 2009 pandemic influenza A(H1N1) in the Netherlands.

Background: The disease burden of the 2009 influenza pandemic has been debated but reliable estimates are lacking. To guide future policy and control, these estimates are necessary. This study uses burden of disease measurements to assess the contribution of the pandemic influenza A(H1N1) virus to the overall burden of disease in the Netherlands. Methods: The burden of disease caused by 2009 pandemic influenza was estimated by calculating Disability Adjusted Life Years (DALY), a composite measure that combines incidence, sequelae and mortality associated with a disease, taking duration and severity into account. Available influenza surveillance data sources (primary care sentinel surveillance, notification data on hospitalizations and deaths and death registries) were used. Besides a baseline scenario, five alternative scenarios were used to assess effects of changing values of input parameters. Results: The baseline scenario showed a loss of 5800 DALY for the Netherlands (35 DALY per 100 000 population). This corresponds to 0.13% of the estimated annual disease burden in the Netherlands and is comparable to the estimated disease burden of seasonal influenza, despite a different age distribution in incidence and mortality of the pandemic compared to seasonal influenza. Conclusions: This disease burden estimate confirmed that, although there was a higher mortality observed among young people, the 2009 pandemic was overall a mild influenza epidemic. The disease burden of this pandemic was comparable to the burden of seasonal influenza in the Netherlands. (aut. ref.