Neuraminidase inhibitors were widely used in the UK during the 2009 influenza A(H1N1) pandemic

Nguyen-Van-Tam, Jonathan S.; Nicholson, Karl G.

doi:10.1016/j.jcv.2010.10.019

Cited by 3 publications

(2 citation statements)

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“…The proof-of-concept implementation of our decision framework is based on the UK National Pandemic Flu Service which operated in 2009 and sought to divert pressure away from primary care services. Using this approach 1.2 million treatment courses of antivirals drugs were dispensed[36]. It is intended that this system will be used again in the future[37], and other countries are now considering similar models[38].…”

Section: Discussionmentioning

confidence: 99%

A novel framework for evaluating the impact of individual decision-making on public health outcomes and its potential application to study antiviral treatment collection during an influenza pandemic

2019

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The importance of accounting for social and behavioural processes when studying public health emergencies has been well-recognised. For infectious disease outbreaks in particular, several methods of incorporating individual behaviour have been put forward, but very few are based on established psychological frameworks. In this paper, we develop a decision framework based on the COM-B model of behaviour change to investigate the impact of individual decision-making on public health outcomes. We demonstrate the application of our decision framework in a proof-of-concept case study based on the 2009 A(H1N1) influenza pandemic in the UK. The National Pandemic Flu Service (NPFS) was set up in England during the pandemic as a means to provide antiviral (AV) treatment to clinically ill patients with influenza-like illness, via telephone calls or internet screening, thereby averting the need to see a doctor. The evaluated patients based on a clinical algorithm and authorised AV drugs for collection via community collection points. We applied our behavioural framework to evaluate the influence of human behaviour on AV collection rates, and subsequently to identify interventions that could help improve AV collection rates. Our model was validated against empirically collected pandemic data from 2009 in the UK. We also performed a sensitivity analysis to identify potentially effective interventions by varying model parameters. Using our behavioural framework in a proof-of-concept case study, we found that interventions geared towards increasing people’s ‘Capability’ and ‘Opportunity’ are likely to result in increased AV collection, potentially resulting in fewer influenza-related hospitalisations and deaths. We note that important behavioural data from public health emergencies are largely scarce. Insights obtained from models such as ours can, not only be very useful in designing healthcare interventions, but also inform future data collection.

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Section: Discussionmentioning

confidence: 99%

A novel framework for evaluating the impact of individual decision-making on public health outcomes and its potential application to study antiviral treatment collection during an influenza pandemic

2019

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“…This would reduce the cost of the stockpile significantly. For example, in the 2009 pandemic only 0.5% of symptomatic cases were hospitalised 32 , these patients would require far fewer doses than the 1.16 million courses (at a minimum) of NAIs dispensed in the 2009 pandemic 33 . For a population of 50.5 million adults with a CAR of 25%, a hospitalisation probability of 0.5% would lead to only approximately 60,000 admissions.…”

Section: Discussionmentioning

confidence: 99%

Evidence synthesis and decision modelling to support complex decisions: stockpiling neuraminidase inhibitors for pandemic influenza usage

et al. 2017

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Objectives: The stockpiling of neuraminidase inhibitor (NAI) antivirals as a defence against pandemic influenza is a significant public health policy decision that must be made despite a lack of conclusive evidence from randomised controlled trials regarding the effectiveness of NAIs on important clinical end points such as mortality. The objective of this study was to determine whether NAIs should be stockpiled for treatment of pandemic influenza on the basis of current evidence. Methods: A decision model for stockpiling was designed. Data on previous pandemic influenza epidemiology was combined with data on the effectiveness of NAIs in reducing mortality obtained from a recent individual participant meta-analysis using observational data. Evidence synthesis techniques and a bias modelling method for observational data were used to incorporate the evidence into the model. The stockpiling decision was modelled for adults (≥16 years old) and the United Kingdom was used as an example. The main outcome was the expected net benefits of stockpiling in monetary terms. Health benefits were estimated from deaths averted through stockpiling. Results: After adjusting for biases in the estimated effectiveness of NAIs, the expected net benefit of stockpiling in the baseline analysis was £444 million, assuming a willingness to pay of £20,000/QALY ($31,000/QALY). The decision would therefore be to stockpile NAIs. There was a greater probability that the stockpile would not be utilised than utilised. However, the rare but catastrophic losses from a severe pandemic justified the decision to stockpile. Conclusions: Taking into account the available epidemiological data and evidence of effectiveness of NAIs in reducing mortality, including potential biases, a decision maker should stockpile anti-influenza medication in keeping with the postulated decision rule.

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Evidence synthesis and decision modelling to support complex decisions: stockpiling neuraminidase inhibitors for pandemic influenza usage

et al. 2016

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Neuraminidase inhibitors were widely used in the UK during the 2009 influenza A(H1N1) pandemic

Cited by 3 publications

References 1 publication

A novel framework for evaluating the impact of individual decision-making on public health outcomes and its potential application to study antiviral treatment collection during an influenza pandemic

A novel framework for evaluating the impact of individual decision-making on public health outcomes and its potential application to study antiviral treatment collection during an influenza pandemic

Evidence synthesis and decision modelling to support complex decisions: stockpiling neuraminidase inhibitors for pandemic influenza usage

Evidence synthesis and decision modelling to support complex decisions: stockpiling neuraminidase inhibitors for pandemic influenza usage

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