Economic Analysis of Pandemic Influenza Vaccination Strategies in Singapore

Lee, Vernon J.; Tok, Mei Yin; Chow, Vincent T. K.; Phua, Kai Hong; Ooi, Eng Eong; Tambyah, Paul Ananth; Chen, Mark

doi:10.1371/journal.pone.0007108

Cited by 26 publications

(23 citation statements)

References 25 publications

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“…One multi-country study assessed vaccine coverage in relation to gross national income per capita as well as the impact of increasing income and education on coverage rates [32]. Two studies assessed the factors that impact cost-effectiveness of pre-pandemic and pandemic vaccine including vaccine strain match, availability and cost [127], [128].…”

Section: Resultsmentioning

confidence: 99%

A Review of the Evidence to Support Influenza Vaccine Introduction in Countries and Areas of WHO's Western Pacific Region

2013

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BackgroundImmunization against influenza is considered an essential public health intervention to control both seasonal epidemics and pandemic influenza. According to the World Health Organization (WHO), there are five key policy and three key programmatic issues that decision-makers should consider before introducing a vaccine. These are (a) public health priority, (b) disease burden, (c) efficacy, quality and safety of the vaccine, (d) other inventions, (e) economic and financial issues, (f) vaccine presentation, (g) supply availability and (h) programmatic strength. We analyzed the body of evidence currently available on these eight issues in the WHO Western Pacific Region.Methodology/Principal FindingsStudies indexed in PubMed and published in English between 1 January 2000 and 31 December 2010 from the 37 countries and areas of the Western Pacific Region were screened for keywords pertaining to the five policy and three programmatic issues. Studies were grouped according to country income level and vaccine target group. There were 133 articles that met the selection criteria, with most (90%) coming from high-income countries. Disease burden (n = 34), vaccine efficacy, quality and safety (n = 27) and public health priority (n = 27) were most frequently addressed by studies conducted in the Region. Many studies assessed influenza vaccine policy and programmatic issues in the general population (42%), in the elderly (24%) and in children (17%). Few studies (2%) addressed the eight issues relating to pregnant women.Conclusions/SignificanceThe evidence for vaccine introduction in countries and areas in this Region remains limited, particularly in low- and middle-income countries that do not currently have influenza vaccination programmes. Surveillance activities and specialized studies can be used to assess the eight issues including disease burden among vaccine target groups and the cost-effectiveness of influenza vaccine. Multi-country studies should be considered to maximize resource utilization for cross-cutting issues such as vaccine presentation and other inventions.

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Section: Resultsmentioning

confidence: 99%

A Review of the Evidence to Support Influenza Vaccine Introduction in Countries and Areas of WHO's Western Pacific Region

2013

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“…Hospitalisation costs were determined by multiplying average cost per day by average length of stay for each age group [32]–[34]. Hospitalisation costs and costs involving medical practitioner visits are taken from the literature [35]–[37]; values are given in Table 1.…”

Section: Methodsmentioning

confidence: 99%

The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis

2013

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BackgroundThe impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning.MethodsA cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ∼30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR), using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR.ResultsIntervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS) for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5%) the cost is ∼$9 k per LYS; for a low severity pandemic (CFR of 0.1%) this strategy costs ∼$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03%) the cost is ∼$155 per LYS. With high severity pandemics (CFR >0.75%) the most effective attack rate reduction strategies are also the most cost effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death.ConclusionsThe most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in reducing the infection rate.

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“…One advocates, for example, 26 weeks of school closure in conjunction with other policies [4]. For other modes of intervention, a number of studies simultaneously assess epidemiological and economic impacts using stochastic agent-based models of pandemic influenza transmission and decisionanalytic approaches [4,12,[20][21][22]. While a few of these consider one or very few school closure options among a larger spectrum of intervention measures [4,12,23], none systematically explore the cost effectiveness and epidemiological impact of a large set of school closure policies nor assess the political, social or economic viability of such policies for mild pandemics such as 2009 H1N1 [24].…”

Section: Introductionmentioning

confidence: 99%

Simulating school closure policies for cost effective pandemic decision making

et al. 2012

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Background Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP) and closure durations. Results Assuming a willingness to pay per quality adjusted life-year (QALY) threshold equal to the US per capita GDP ($46,000), we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP) with the longest duration closure (24 weeks) considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates). Conclusions These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic.

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Economic Analysis of Pandemic Influenza Vaccination Strategies in Singapore

Cited by 26 publications

References 25 publications

A Review of the Evidence to Support Influenza Vaccine Introduction in Countries and Areas of WHO's Western Pacific Region

A Review of the Evidence to Support Influenza Vaccine Introduction in Countries and Areas of WHO's Western Pacific Region

The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis

Simulating school closure policies for cost effective pandemic decision making

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