Health Outcomes and Costs of Community Mitigation Strategies for an Influenza Pandemic in the United States

Perlroth, Daniella; Glass, Robert J.; Davey, Victoria J.; Cannon, Daniel C.; Garber, Alan M.; Owens, Douglas K

doi:10.1086/649867

Cited by 69 publications

(97 citation statements)

References 38 publications

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“…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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Section: Introductionmentioning

confidence: 99%

Simulating school closure policies for cost effective pandemic decision making

et al. 2012

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“…They also conclude that pre-pandemic vaccines are important for critical infrastructures to continue to operate during the pandemic. In another study, Perlroth et al [47]use the same agent-based stochastic simulation model to again evaluate a portfolio of interventions, but this time also evaluating the costeffectiveness of these interventions. They find that a combination strategy of social distancing, school closure, and providing antivirals would be a cost-effective strategy to deal with an influenza pandemic with moderate infectivity and mortality similar to 1918.…”

Section: Simulation Modeling: Agent-based Simulationmentioning

confidence: 99%

“…• Stockpiling antivirals for treatment is valuable [26,31,47,[50][51][52]54] • Stockpiling antivirals for prevention may be valuable [26, 39-42, 44, 45, 47] • Vaccines would be valuable if available, even with modest efficacy [25,27,30,[40][41][42][43][44][45][46] • Vaccines should first be allocated to school-age children to minimize the impact to the overall population [32,43] Social distancing:…”

Section: Conclusion and Policy Implicationsmentioning

confidence: 99%

“…• Travel restrictions are unlikely to have a major impact [25,40] • Social distancing interventions in general may not be as effective or costeffective as pharmaceutical interventions [44,47] • Social distancing could be a key policy tool -At the very beginning of a pandemic outbreak [39,42] -Or in a general pandemic, if the disease is highly infectious and if used in conjunction with other interventions [40,[44][45][46][47] Multiple interventions:…”

Section: Conclusion and Policy Implicationsmentioning

confidence: 99%

“…• Multiple interventions used in combination are likely to be highly effective [39,40,42,[44][45][46][47] • Dynamic models should be used to determine the best portfolio of interventions [33] Distribution systems:…”

Section: Conclusion and Policy Implicationsmentioning

confidence: 99%

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Review of Operations Research Tools and Techniques Used for Influenza Pandemic Planning

Hutton

2013

International Series in Operations Research &Amp; Management Science

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Many public health officials are concerned about a possible influenza pandemic. The three pandemics in the twentieth century killed between 50 and 100 million people and the 2009 H1N1 "Swine Flu" exposed vulnerabilities that we still have to influenza epidemics. Operations research tools and techniques can analyze public health interventions to mitigate the impact of pandemic influenza. In this chapter we review an array of examples of how operations research tools can be used to improve pandemic influenza prevention and response. From this, we derive insights into the appropriateness of certain techniques for answering specific questions and we propose preliminary policy recommendations. We then discuss opportunities for future research. IntroductionPandemic influenza is a major global public health concern. If future pandemics are anything like past ones they could kill hundreds of millions of people. The analytical tools of operations research are capable of helping policymakers allocate resources to combat pandemic influenza in a more efficient and effective manner.This chapter gives a brief overview of pandemic influenza and possible public health responses. We then review current examples of how operations research techniques have been applied to the problem of pandemic influenza. Finally, we see some broad policy conclusions from this research, see how different operations research tools might be best applied to certain problems, and identify areas for future application of operations research to pandemic influenza.

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