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Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic.
Ann Intern Med. 2009 Dec 15; 151(12):840-53.AIM

Abstract

BACKGROUND

The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century.

OBJECTIVE

To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies.

DESIGN

Compartmental epidemic model in conjunction with a Markov model of disease progression.

DATA SOURCES

Literature and expert opinion.

TARGET POPULATION

Residents of a U.S. metropolitan city with a population of 8.3 million.

TIME HORIZON

Lifetime.

PERSPECTIVE

Societal.

INTERVENTIONS

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.

OUTCOME MEASURES

Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.

RESULTS OF BASE-CASE ANALYSIS

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.

RESULTS OF SENSITIVITY ANALYSIS

Expanded vaccination remained incrementally cost-effective over a wide range of assumptions.

LIMITATIONS

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.

CONCLUSION

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.

PRIMARY FUNDING SOURCE

National Institutes of Health and Agency for Healthcare Research and Quality.

Authors+Show Affiliations

Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3143, Stanford, CA 94305, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

20008760

Citation

Khazeni, Nayer, et al. "Effectiveness and Cost-effectiveness of Expanded Antiviral Prophylaxis and Adjuvanted Vaccination Strategies for an Influenza a (H5N1) Pandemic." Annals of Internal Medicine, vol. 151, no. 12, 2009, pp. 840-53.
Khazeni N, Hutton DW, Garber AM, et al. Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic. Ann Intern Med. 2009;151(12):840-53.
Khazeni, N., Hutton, D. W., Garber, A. M., & Owens, D. K. (2009). Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic. Annals of Internal Medicine, 151(12), 840-53. https://doi.org/10.7326/0003-4819-151-12-200912150-00156
Khazeni N, et al. Effectiveness and Cost-effectiveness of Expanded Antiviral Prophylaxis and Adjuvanted Vaccination Strategies for an Influenza a (H5N1) Pandemic. Ann Intern Med. 2009 Dec 15;151(12):840-53. PubMed PMID: 20008760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic. AU - Khazeni,Nayer, AU - Hutton,David W, AU - Garber,Alan M, AU - Owens,Douglas K, PY - 2009/12/17/entrez PY - 2009/12/17/pubmed PY - 2010/11/17/medline SP - 840 EP - 53 JF - Annals of internal medicine JO - Ann Intern Med VL - 151 IS - 12 N2 - BACKGROUND: The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century. OBJECTIVE: To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies. DESIGN: Compartmental epidemic model in conjunction with a Markov model of disease progression. DATA SOURCES: Literature and expert opinion. TARGET POPULATION: Residents of a U.S. metropolitan city with a population of 8.3 million. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTIONS: 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. OUTCOME MEASURES: Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: 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. RESULTS OF SENSITIVITY ANALYSIS: Expanded vaccination remained incrementally cost-effective over a wide range of assumptions. LIMITATIONS: 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. CONCLUSION: 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. PRIMARY FUNDING SOURCE: National Institutes of Health and Agency for Healthcare Research and Quality. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/20008760/Effectiveness_and_cost_effectiveness_of_expanded_antiviral_prophylaxis_and_adjuvanted_vaccination_strategies_for_an_influenza_A__H5N1__pandemic_ L2 - https://www.acpjournals.org/doi/10.7326/0003-4819-151-12-200912150-00156?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -