Systematic Review of Economic Evaluations of Preparedness Strategies and Interventions against Influenza Pandemics

Abstract

BackgroundAlthough public health guidelines have implications for resource allocation, these issues were not explicitly considered in previous WHO pandemic preparedness and response guidance. In order to ensure a thorough and informed revision of this guidance following the H1N1 2009 pandemic, a systematic review of published and unpublished economic evaluations of preparedness strategies and interventions against influenza pandemics was conducted.MethodsThe search was performed in September 2011 using 10 electronic databases, 2 internet search engines, reference list screening, cited reference searching, and direct communication with relevant authors. Full and partial economic evaluations considering both costs and outcomes were included. Conversely, reviews, editorials, and studies on economic impact or complications were excluded. Studies were selected by 2 independent reviewers.Results44 studies were included. Although most complied with the cost effectiveness guidelines, the quality of evidence was limited. However, the data sources used were of higher quality in economic evaluations conducted after the 2009 H1N1 pandemic. Vaccination and drug regimens were varied. Pharmaceutical plus non-pharmaceutical interventions are relatively cost effective in comparison to vaccines and/or antivirals alone. Pharmaceutical interventions vary from cost saving to high cost effectiveness ratios. According to ceiling thresholds (Gross National Income per capita), the reduction of non-essential contacts and the use of pharmaceutical prophylaxis plus the closure of schools are amongst the cost effective strategies for all countries. However, quarantine for household contacts is not cost effective even for low and middle income countries.ConclusionThe available evidence is generally inconclusive regarding the cost effectiveness of preparedness strategies and interventions against influenza pandemics. Studies on their effectiveness and cost effectiveness should be readily implemented in forthcoming events that also involve the developing world. Guidelines for assessing the impact of disease and interventions should be drawn up to facilitate these studies.

Glycan receptor specificity as a useful tool for characterization and surveillance of influenza A virus

“…Influenza A, a zoonotic disease, represents a substantial public health burden, especially in the case of epidemic or pandemic outbreaks [1, 2]. Influenza A virus subtypes, found naturally in aquatic birds, are identified according to their surface antigens: hemagglutinin (HA) and neuraminidase (NA).…”

Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings

“…Among the very few reviews on relevant topics our search retrieved, most of them have focused on a specific disease area, geographic location, non low and middle-income country (LMIC) region, or type of intervention. [13][14][15][16][17] Other reviews have also focused mainly on examining individual behaviors within affected groups or populations. 18,19 Finally, most reviews 20,21 focus on actual mitigation measures (e.g.…”

Cost–effectiveness analysis of pandemic influenza preparedness: what’s missing?

“…In a recent systematic review, Pérez Velasco et al identified 44 economic evaluations of pandemic preparedness strategies. 3 Although the first of these was published in 1999, the majority (75%) were published from 2009 onwards. Pérez Velasco et al evaluated these 44 studies against a checklist of standard practices in the field of economic evaluation, but their stated aim was to summarize the literature and offer policy recommendations rather than to examine methodological approaches.…”