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Health outcomes and costs of community mitigation strategies for an influenza pandemic in the United States.
Clin Infect Dis. 2010 Jan 15; 50(2):165-74.CI

Abstract

BACKGROUND

The optimal community-level approach to control pandemic influenza is unknown.

METHODS

We estimated the health outcomes and costs of combinations of 4 social distancing strategies and 2 antiviral medication strategies to mitigate an influenza pandemic for a demographically typical US community. We used a social network, agent-based model to estimate strategy effectiveness and an economic model to estimate health resource use and costs. We used data from the literature to estimate clinical outcomes and health care utilization.

RESULTS

At 1% influenza mortality, moderate infectivity (R(o) of 2.1 or greater), and 60% population compliance, the preferred strategy is adult and child social distancing, school closure, and antiviral treatment and prophylaxis. This strategy reduces the prevalence of cases in the population from 35% to 10%, averts 2480 cases per 10,000 population, costs $2700 per case averted, and costs $31,300 per quality-adjusted life-year gained, compared with the same strategy without school closure. The addition of school closure to adult and child social distancing and antiviral treatment and prophylaxis, if available, is not cost-effective for viral strains with low infectivity (R(o) of 1.6 and below) and low case fatality rates (below 1%). High population compliance lowers costs to society substantially when the pandemic strain is severe (R(o) of 2.1 or greater).

CONCLUSIONS

Multilayered mitigation strategies that include adult and child social distancing, use of antivirals, and school closure are cost-effective for a moderate to severe pandemic. Choice of strategy should be driven by the severity of the pandemic, as defined by the case fatality rate and infectivity.

Authors+Show Affiliations

Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. dperl@stanford.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20021259

Citation

Perlroth, Daniella J., et al. "Health Outcomes and Costs of Community Mitigation Strategies for an Influenza Pandemic in the United States." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 50, no. 2, 2010, pp. 165-74.
Perlroth DJ, Glass RJ, Davey VJ, et al. Health outcomes and costs of community mitigation strategies for an influenza pandemic in the United States. Clin Infect Dis. 2010;50(2):165-74.
Perlroth, D. J., Glass, R. J., Davey, V. J., Cannon, D., Garber, A. M., & Owens, D. K. (2010). Health outcomes and costs of community mitigation strategies for an influenza pandemic in the United States. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 50(2), 165-74. https://doi.org/10.1086/649867
Perlroth DJ, et al. Health Outcomes and Costs of Community Mitigation Strategies for an Influenza Pandemic in the United States. Clin Infect Dis. 2010 Jan 15;50(2):165-74. PubMed PMID: 20021259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health outcomes and costs of community mitigation strategies for an influenza pandemic in the United States. AU - Perlroth,Daniella J, AU - Glass,Robert J, AU - Davey,Victoria J, AU - Cannon,Daniel, AU - Garber,Alan M, AU - Owens,Douglas K, PY - 2009/12/22/entrez PY - 2009/12/22/pubmed PY - 2010/3/4/medline SP - 165 EP - 74 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 50 IS - 2 N2 - BACKGROUND: The optimal community-level approach to control pandemic influenza is unknown. METHODS: We estimated the health outcomes and costs of combinations of 4 social distancing strategies and 2 antiviral medication strategies to mitigate an influenza pandemic for a demographically typical US community. We used a social network, agent-based model to estimate strategy effectiveness and an economic model to estimate health resource use and costs. We used data from the literature to estimate clinical outcomes and health care utilization. RESULTS: At 1% influenza mortality, moderate infectivity (R(o) of 2.1 or greater), and 60% population compliance, the preferred strategy is adult and child social distancing, school closure, and antiviral treatment and prophylaxis. This strategy reduces the prevalence of cases in the population from 35% to 10%, averts 2480 cases per 10,000 population, costs $2700 per case averted, and costs $31,300 per quality-adjusted life-year gained, compared with the same strategy without school closure. The addition of school closure to adult and child social distancing and antiviral treatment and prophylaxis, if available, is not cost-effective for viral strains with low infectivity (R(o) of 1.6 and below) and low case fatality rates (below 1%). High population compliance lowers costs to society substantially when the pandemic strain is severe (R(o) of 2.1 or greater). CONCLUSIONS: Multilayered mitigation strategies that include adult and child social distancing, use of antivirals, and school closure are cost-effective for a moderate to severe pandemic. Choice of strategy should be driven by the severity of the pandemic, as defined by the case fatality rate and infectivity. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/20021259/Health_outcomes_and_costs_of_community_mitigation_strategies_for_an_influenza_pandemic_in_the_United_States_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/649867 DB - PRIME DP - Unbound Medicine ER -