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thorough and informed revision of this guidance following the H1N1 2009 pandemic, a systematic review of published and unpublished economic evaluations of preparedness strategies and interventions against influenza pandemics was conducted.MethodsThe search was performed in September 2011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.
Highlights
When a new subtype of influenza A virus which is infectious to humans gains human-to-human transmissibility efficiently enough to cause community level outbreaks, this virus is said to have pandemic potential
Data Sources and Searches On 22 September 2011, a systematic search was performed in MEDLINE, as well as in the specialist databases NHS EED, HEED, CEA Registry (1976–2010), EURONHEED, HTA, Health Evidence Network (HEN), EconLit, and Research Papers in Economics (RePEc)
Since it was expected that a majority of pharmaceutical interventions would be identified from the abovementioned databases, a search through the Social Science Citation Index (SSCI), which is more focused on non-pharmaceutical issues and covers conference proceedings, was performed
Summary
When a new subtype of influenza A virus which is infectious to humans gains human-to-human transmissibility efficiently enough to cause community level outbreaks, this virus is said to have pandemic potential. If this new subtype spreads globally causing disease and deaths, it becomes pandemic. [1] In March 2009, a new subtype of influenza A H1N1 virus was identified in Mexico and the United States. It spread to all continents in less than nine weeks becoming the first pandemic of the 21st century. 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
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