Systematic Review of Economic Evaluations of Preparedness Strategies and Interventions against Influenza Pandemics

BACKGROUND: Although public health guidelines have implications for resource allocation, these issues were not explicitly considered in previous WHO pandemic preparedness and response guidance. In order to ensure a thorough and informed revision of this guidance following the H1N1 2009 pandemic, a systematic review of published and unpublished economic evaluations of preparedness strategies and interventions against influenza pandemics was conducted. METHODS: The search was performed in September 2011 using 10 electronic databases, 2 internet search engines, reference list screening, cited reference searching, and direct communication with relevant authors. Full and partial economic evaluations considering both costs and outcomes were included. Conversely, reviews, editorials, and studies on economic impact or complications were excluded. Studies were selected by 2 independent reviewers. RESULTS: 44 studies were included. Although most complied with the cost effectiveness guidelines, the quality of evidence was limited. However, the data sources used were of higher quality in economic evaluations conducted after the 2009 H1N1 pandemic. Vaccination and drug regimens were varied. Pharmaceutical plus non-pharmaceutical interventions are relatively cost effective in comparison to vaccines and/or antivirals alone. Pharmaceutical interventions vary from cost saving to high cost effectiveness ratios. According to ceiling thresholds (Gross National Income per capita), the reduction of non-essential contacts and the use of pharmaceutical prophylaxis plus the closure of schools are amongst the cost effective strategies for all countries. However, quarantine for household contacts is not cost effective even for low and middle income countries. CONCLUSION: The available evidence is generally inconclusive regarding the cost effectiveness of preparedness strategies and interventions against influenza pandemics. Studies on their effectiveness and cost effectiveness should be readily implemented in forthcoming events that also involve the developing world. Guidelines for assessing the impact of disease and interventions should be drawn up to facilitate these studies

On the existence of a threshold for preventive behavioral responses to suppress epidemic spreading

The spontaneous behavioral responses of individuals to the progress of an epidemic are recognized to have a significant impact on how the infection spreads. One observation is that, even if the infection strength is larger than the classical epidemic threshold, the initially growing infection can diminish as the result of preventive behavioral patterns adopted by the individuals. In order to investigate such dynamics of the epidemic spreading, we use a simple behavioral model coupled with the individual-based SIS epidemic model where susceptible individuals adopt a preventive behavior when sensing infection. We show that, given any infection strength and contact topology, there exists a region in the behavior-related parameter space such that infection cannot survive in long run and is completely contained. Several simulation results, including a spreading scenario in a realistic contact network from a rural district in the State of Kansas, are presented to support our analytical arguments

An Efficient Heuristic for Pooled Repair Shop Designs

An effective spare part supply system planning is essential to achieve a high capital asset availability. We investigate the design problem of a repair shop in a single echelon repairable multi-item spare parts supply system. The repair shop usually consists of several servers with different skill sets. Once a failure occurs in the system, the failed part is queued to be served by a suitable server that has the required skill. We model the repair shop as a collection of independent sub-systems, where each sub-system is responsible for repairing certain types of failed parts. The procedure of partitioning a repair shop into sub-systems is known as pooling, and the repair shop formed by the union of independent sub-systems is called a pooled repair shop. Identifying the best partition is a challenging combinatorial optimization problem. In this direction, we formulate the problem as a stochastic nonlinear integer programming model and propose a sequential solution heuristic to find the best-pooled design by considering inventory allocation and capacity level designation of the repair shop. We conduct numerical experiments to quantify the value of the pooled repair shop designs. Our analysis shows that pooled designs can yield cost reductions by 25% to 45% compared to full flexible and dedicated designs. The proposed heuristic also achieves a lower average total system cost than that generated by a Genetic Algorithm (GA)-based solution algorithm. - 2019, Springer Nature Switzerland AG.Acknowledgement. This research was made possible by the NPRP award [NPRP 7-308-2-128] from the Qatar National Research Fund (a member of The Qatar Foundation). The statements made herein are solely the responsibility of the author[s].Scopu