Cost-effectiveness of workplace closure and travel restriction for mitigating influenza outbreaks

Abstract

Background: Social distancing strategies, such as workplace closure and travel restriction, have been widely considered as alternative measures to contain influenza viruses, particularly when vaccines and antiviral drugs are under development. However, their cost-effectiveness in large urbanized populations is poorly understood.Method: To fill this knowledge gap, this research builds a spatially-explicit network-based model to simulate influenza transmission, mitigation strategies, and their associated costs. This model represents a spatio-temporal network of individuals' daily contacts, which enables the simulation of local infection and long-distance dispersion of influenza. The workplace closure and travel restriction strategies, as well as their combinations with antiviral prophylaxis, are incorporated into this model to estimate their cost-effectiveness in mitigating seasonal flu and pandemic flu. The metropolitan area of Buffalo, NY, USA, with a population about 1 million, is selected as the study area.Results: Without any intervention, the seasonal flu and pandemic flu cost $234.1 million and $331.1 million, respectively. The closure of 30% affected workplace is the most cost-effective single strategy with $12.9K per case averted for seasonal flu and $34.9K for pandemic flu. The travel restriction is not cost-effective if applied alone, but a 50% travel restriction in combination with antiviral prophylaxis and workplace closure forms the best strategy, which only costs $10.6K per cases averted for seasonal flu and $13.5K for pandemic flu.Conclusions: For a large urbanized area, the closure of affected workplaces could be an effective and cost-saving strategy to mitigate influenza outbreaks, while the highest cost-effectiveness can be achieved by combining the travel restriction with antiviral prophylaxis and workplace closure.