Abstract
BackgroundThe purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations.MethodsWe developed two models: a dynamic disease model capturing the spread of influenza and an economic model capturing the costs and benefits of school closure. Decisions were based on quality-adjusted life years gained using incremental cost-effectiveness ratios. The disease model is an age-structured SEIR compartmental model based on the population of Oslo. We studied the costs and benefits of school closure by varying the age targets (kindergarten, primary school, secondary school) and closure durations (1–10 weeks), given pandemics with basic reproductive number of 1.5, 2.0 or 2.5.ResultsThe cost-effectiveness of school closure varies depending on the target group, duration and whether indirect costs are considered. Using a case fatality rate (CFR) of 0.1-0.2% and with current cost-effectiveness threshold for Norway, closing secondary school is the only cost-effective strategy, when indirect costs are included. The most cost-effective strategies would be closing secondary schools for 8 weeks if R0=1.5, 6 weeks if R0=2.0, and 4 weeks if R0= 2.5. For severe pandemics with case fatality rates of 1-2%, similar to the Spanish flu, or when indirect costs are disregarded, the optimal strategy is closing kindergarten, primary and secondary school for extended periods of time. For a pandemic with 2009 H1N1 characteristics (mild severity and low transmissibility), closing schools would not be cost-effective, regardless of the age target of school children.ConclusionsSchool closure has moderate impact on the epidemic’s scope, but the resulting disruption to society imposes a potentially great cost in terms of lost productivity from parents’ work absenteeism.
Highlights
The purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations
In Scenario B, we introduced a 50% reduction in same age contacts among care-taking parents absent from work; in Scenario C we reduced the same age contact of dismissed children by 50% instead of 90% in the base case, and by 10% with other age groups instead of 25% to simulate low compliance among affected children; in Scenario D we increased the case fatality rate (CFR) by a factor of 10 compared to the baseline scenarios, using CFR of 1-2% in children and adults below 65 years similar to the level observed during the Spanish flu [30]; in Scenario E we reduced the CFR by a factor of 10 relative to the baseline scenarios, using CFR of 0.01-0.02% to simulate a mild pandemic
To avoid restarting the epidemic, we found that closure must be effective for at least 3–4 week for R0 =1.5, and 2–3 weeks when the transmissibility is higher
Summary
The purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations. Influenza pandemics occur at irregular intervals and cause significant mortality and morbidity as well as substantial economic losses [1]. School closure is a possible strategy for mitigating transmission during the early phase of a pandemic when vaccine is not yet available. School closure has three main consequences: reducing the total disease burden, postponing the peak of Schools are thought to play a special role in transmission due to high contact rates among school children combined with higher susceptibility among children compared with adults. Extended school closure is costly and may cause significant disruption to local communities by keeping working parents away from work and reducing school children’s learning time. Quantifying the costs and benefits of school closure might help inform pandemic policy making
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