title: The cost-effectiveness of strategies to reduce mortality from an intentional release of aerosolized anthrax spores.
abstract: BACKGROUND
  Intentional exposures to aerosolized Bacillus anthracis spores have caused fatalities.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of strategies to reduce mortality from future inhalational anthrax exposures.
  
  
  METHODS
  Computer cohort simulation of a 100,000-person single-site exposure (worst-case scenario) and a 100-person multiple-site exposure (resembling the recent US attack). For each scenario, universal vaccination and an emergency surveillance and response (ESR) system were compared with a default strategy that assumed eventual discovery of the exposure.
  
  
  RESULTS
  If an exposure was unlikely to occur or was small in scale, neither vaccination nor an ESR system was cost-effective. If an exposure was certain and large in scale, an ESR system was more cost-effective than vaccination ($73 v. $29,600 per life-year saved), and a rapid response saved more lives than improved surveillance.
  
  
  CONCLUSIONS
  Strategies to reduce deaths from anthrax attacks are cost-effective only if large exposures are certain. A faster response is more beneficial than enhanced surveillance.
authors.affiliation: Section of General Internal Medicine, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA. ronald.braithwaite@med.va.gov
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.forename: Douglas
authors.initials: D
authors.lastname: Fridsma
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D000335:Aerosol Propellants; D000881:Anthrax / Q000401:mortality* / Q000517:prevention & control; D001408:Bacillus anthracis / Q000472:pathogenicity; D023482:Bioterrorism / Q000191:economics*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics; D006801:Humans; D019570:Inhalation Exposure; D011159:Population Surveillance; D014481:United States / Q000453:epidemiology; D014611:Vaccination
chemical_list: D000335:Aerosol Propellants