Abstract
Pandemics and major outbreaks have the potential to cause large health losses and major economic costs. To prioritize between preventive and responsive interventions, it is important to understand the costs and health losses interventions may prevent. We review the literature, investigating the type of studies performed, the costs and benefits included, and the methods employed against perceived major outbreak threats. We searched PubMed and SCOPUS for studies concerning the outbreaks of SARS in 2003, H5N1 in 2003, H1N1 in 2009, Cholera in Haiti in 2010, MERS-CoV in 2013, H7N9 in 2013, and Ebola in West-Africa in 2014. We screened titles and abstracts of papers, and subsequently examined remaining full-text papers. Data were extracted according to a pre-constructed protocol. We included 34 studies of which the majority evaluated interventions related to the H1N1 outbreak in a high-income setting. Most interventions concerned pharmaceuticals. Included costs and benefits, as well as the methods applied, varied substantially between studies. Most studies used a short time horizon and did not include future costs and benefits. We found substantial variation in the included elements and methods used. Policymakers need to be aware of this and the bias toward high-income countries and pharmaceutical interventions, which hampers generalizability. More standardization of included elements, methodology, and reporting would improve economic evaluations and their usefulness for policy.
Highlights
Infectious disease outbreaks have proven to be potentially devastating
This study identified a substantial number of studies evaluating intervention strategies for important recent major outbreaks in terms of costs and benefits
We found a strong focus on the H1N1 outbreak and a clear bias toward highincome settings
Summary
Infectious disease outbreaks have proven to be potentially devastating. The number of outbreaks of infectious diseases has been increasing since 1980, as has the number of unique pathogens [2]. To prevent and effectively combat outbreaks, reporting agreements such as those arranged in the International Health Regulations (IHR) between national governments and international organizations were established [3]. The current IHR require the countries which ratified them to develop a minimum capacity of core functions related to surveillance and response [3]. With new threats emerging and given the fragile health systems in many parts of the world, outbreaks still have the potential to occur with potentially severe consequences in multiple countries. There is a continuous pressure to improve available detection and response systems, and to increase the possibilities of preventing new threats from doing too much harm
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