Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission

Abstract

BackgroundThere has been increasing debate surrounding mask and respirator interventions to control respiratory infection transmission in both healthcare and community settings. As decision makers are considering the recommendations they should evaluate how to provide the most efficient protection strategies with minimum costs. The aim of this review is to identify and evaluate the existing economic evaluation literature in this area and to offer advice on how future evaluations on this topic should be conducted.MethodsWe searched the Scopus database for all literature on economic evaluation of mask or respirator use to control respiratory infection transmission. Reference lists from the identified studies were also manually searched. Seven studies met our inclusion criteria from the initial 806 studies identified by the search strategy and our manual search.ResultsFive studies considered interventions for seasonal and/or pandemic influenza, with one also considering SARS (Severe Acute Respiratory Syndrome). The other two studies focussed on tuberculosis transmission control interventions. The settings and methodologies of the studies varied greatly. No low-middle income settings were identified. Only one of the reviewed studies cited clinical evidence to inform their mask/respirator intervention effectiveness parameters. Mask and respirator interventions were generally reported by the study authors to be cost saving or cost-effective when compared to no intervention or other control measures, however the evaluations had important limitations.ConclusionsGiven the large cost differential between masks and respirators, there is a need for more comprehensive economic evaluations to compare the relative costs and benefits of these interventions in situations and settings where alternative options are potentially applicable. There are at present insufficient well conducted cost-effectiveness studies to inform decision-makers on the value for money of alternative mask/respirator options.

Assessing the State of Knowledge Regarding the Effectiveness of Interventions to Contain Pandemic Influenza Transmission: A Systematic Review and Narrative Synthesis

“…Eight [26–33] review the effectiveness of pandemic influenza vaccine in preventing influenza and influenza-like illness (ILI); three [34–36] examine the impact of antivirals; two [32, 37] review the effectiveness of seasonal influenza vaccines in preventing pandemic influenza infection; two evaluate the impact of personal protective measures (hand-washing, mask use) [38, 39]; one [40] analyzes the impact of school closure; and another [41] reviews the efficacy of traditional Chinese medicine (TCM). One review [42] evaluates the economic viability of a wide range of pharmaceutical and non-pharmaceutical measures, concluding that social distancing, antiviral prophylaxis, school closure, and vaccination are likely to be cost-effective in all settings, while quarantine is never cost-effective.…”

“…Of the two systematic reviews analyzing personal protective measures an influenza epidemic, one [39] reported on its effectiveness in preventing infection, while the other [38] discussed its economic benefit. Wong et al .…”

“…Mukerji et al . [38] do not report quantitative data on the effectiveness of interventions in preventing infection, but reviewed past cost-effectiveness studies of mask use. Noting important limitations in the studies reviewed, these authors suggest that masks and respirators may be cost-effective, though there is insufficient data to inform more specific interventions.…”

Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections

“…However, it is difficult to compare the results of our evaluation to these previous high income setting studies as they often did not report results in an easily comparable format (e.g. cost per case prevented) and most did not use clinical trial efficacy data to inform their analyses [33].…”

“…The determination of cost-effectiveness will depend on the willingness to pay to prevent a CRI case in a HCW and this varies between countries and is not easily transferrable between different settings. The extent to which a decision maker is likely to focus on cost-effectiveness evidence when it comes to HCW protection will in part depend on the seriousness of the infections being prevented [33,38]. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.…”