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Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic.

ABSTRACT: The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century.To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies.Compartmental epidemic model in conjunction with a Markov model of disease progression.Literature and expert opinion.Residents of a U.S. metropolitan city with a population of 8.3 million.Lifetime.Societal.3 scenarios: 1) vaccination and antiviral pharmacotherapy in quantities similar to those currently available in the U.S. stockpile (stockpiled strategy), 2) stockpiled strategy but with expanded distribution of antiviral agents (expanded prophylaxis strategy), and 3) stockpiled strategy but with adjuvanted vaccine (expanded vaccination strategy). All scenarios assumed standard nonpharmaceutical interventions.Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.Expanded vaccination was the most effective and cost-effective of the 3 strategies, averting 68% of infections and deaths and gaining 404 030 QALYs at $10 844 per QALY gained relative to the stockpiled strategy.Expanded vaccination remained incrementally cost-effective over a wide range of assumptions.The model assumed homogenous mixing of cases and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. We did not model interventions for children or older adults; the model is not designed to target interventions to specific groups.Expanded adjuvanted vaccination is an effective and cost-effective mitigation strategy for an influenza A (H5N1) pandemic. Expanded antiviral prophylaxis can help delay the pandemic while additional strategies are implemented.National Institutes of Health and Agency for Healthcare Research and Quality.

SUBMITTER: Khazeni N

PROVIDER: S-EPMC3428215 | biostudies-literature | 2009 Dec

REPOSITORIES: biostudies-literature

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Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic.

Khazeni Nayer N Hutton David W DW Garber Alan M AM Owens Douglas K DK

Annals of internal medicine 20091201 12

<h4>Background</h4>The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century.<h4>Objective</h4>To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies.<h4>Design</h4>Compartmental epidemic model in conjunction with a Markov model of disease progression.<h4>Data sources</h4>Literature and expert opinion.<h4>Target population</h4>Residents of a U.S. metropolitan city with a population o ...[more]

PMID: 20008760

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Project description:BACKGROUND: A critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided. METHODS: A simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed. RESULTS: Vaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and increased rates of vaccination further improved effectiveness and cost effectiveness. CONCLUSIONS: The effectiveness and cost effectiveness consequences of the time-critical interplay of pandemic dynamics, vaccine availability and intervention timing has been quantified. For moderate and extreme pandemics, vaccination combined with rapidly activated antiviral and social distancing interventions of sufficient duration is cost effective from the perspective of life years saved.

Dataset Information

Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic.

Publications

Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic.

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