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45. Ann Intern Med. 2009 Dec 15;151(12):840-53.
Effectiveness and Cost-Effectiveness of Expanded Antiviral Prophylaxis and
Adjuvanted Vaccination Strategies for an Influenza A (H5N1) Pandemic.
Khazeni N, Hutton DW, Garber AM, Owens DK.
Stanford University and Stanford University Medical Center, Stanford, California,
and Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Background: The pandemic potential of influenza A (H5N1) virus is a prominent
public health concern of the 21st century. Objective: To estimate the
effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation
and response strategies. Design: Compartmental epidemic model in conjunction with
a Markov model of disease progression. Data Sources: Literature and expert
opinion. Target Population: Residents of a U.S. metropolitan city with a
population of 8.3 million. Time Horizon: Lifetime. Perspective: Societal.
Interventions: 3 scenarios: 1) vaccination and antiviral pharmacotherapy in
quantities similar to those currently available in the U.S. stockpile (stockpiled
strategy), 2) stockpiled strategy but with expanded distribution of antiviral
agents (expanded prophylaxis strategy), and 3) stockpiled strategy but with
adjuvanted vaccine (expanded vaccination strategy). All scenarios assumed
standard nonpharmaceutical interventions. Outcome Measures: Infections and deaths
averted, costs, quality-adjusted life-years (QALYs), and incremental
cost-effectiveness. Results of Base-Case Analysis: Expanded vaccination was the
most effective and cost-effective of the 3 strategies, averting 68% of infections
and deaths and gaining 404 030 QALYs at $10 844 per QALY gained relative to the
stockpiled strategy. Results of Sensitivity Analysis: Expanded vaccination
remained incrementally cost-effective over a wide range of assumptions.
Limitations: The model assumed homogenous mixing of cases and contacts;
heterogeneous mixing would result in faster initial spread, followed by slower
spread. We did not model interventions for children or older adults; the model is
not designed to target interventions to specific groups. Conclusion: Expanded
adjuvanted vaccination is an effective and cost-effective mitigation strategy for
an influenza A (H5N1) pandemic. Expanded antiviral prophylaxis can help delay the
pandemic while additional strategies are implemented. Primary Funding Source:
National Institutes of Health and Agency for Healthcare Research and Quality.
PMID: 20008760 [PubMed - in process]
Effectiveness and Cost-Effectiveness of Expanded Antiviral Prophylaxis and
Adjuvanted Vaccination Strategies for an Influenza A (H5N1) Pandemic.
Khazeni N, Hutton DW, Garber AM, Owens DK.
Stanford University and Stanford University Medical Center, Stanford, California,
and Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
Background: The pandemic potential of influenza A (H5N1) virus is a prominent
public health concern of the 21st century. Objective: To estimate the
effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation
and response strategies. Design: Compartmental epidemic model in conjunction with
a Markov model of disease progression. Data Sources: Literature and expert
opinion. Target Population: Residents of a U.S. metropolitan city with a
population of 8.3 million. Time Horizon: Lifetime. Perspective: Societal.
Interventions: 3 scenarios: 1) vaccination and antiviral pharmacotherapy in
quantities similar to those currently available in the U.S. stockpile (stockpiled
strategy), 2) stockpiled strategy but with expanded distribution of antiviral
agents (expanded prophylaxis strategy), and 3) stockpiled strategy but with
adjuvanted vaccine (expanded vaccination strategy). All scenarios assumed
standard nonpharmaceutical interventions. Outcome Measures: Infections and deaths
averted, costs, quality-adjusted life-years (QALYs), and incremental
cost-effectiveness. Results of Base-Case Analysis: Expanded vaccination was the
most effective and cost-effective of the 3 strategies, averting 68% of infections
and deaths and gaining 404 030 QALYs at $10 844 per QALY gained relative to the
stockpiled strategy. Results of Sensitivity Analysis: Expanded vaccination
remained incrementally cost-effective over a wide range of assumptions.
Limitations: The model assumed homogenous mixing of cases and contacts;
heterogeneous mixing would result in faster initial spread, followed by slower
spread. We did not model interventions for children or older adults; the model is
not designed to target interventions to specific groups. Conclusion: Expanded
adjuvanted vaccination is an effective and cost-effective mitigation strategy for
an influenza A (H5N1) pandemic. Expanded antiviral prophylaxis can help delay the
pandemic while additional strategies are implemented. Primary Funding Source:
National Institutes of Health and Agency for Healthcare Research and Quality.
PMID: 20008760 [PubMed - in process]