title: Investment decisions in influenza pandemic contingency planning: cost-effectiveness of stockpiling antiviral drugs.
abstract: BACKGROUND
  The threat of an influenza pandemic has led to stockpiling of antiviral drugs in order to mitigate a plausible outbreak. If the stockpile would be used in relation to the recent pandemic alert, an investment decision about renewing the stock for a possible subsequent pandemic is essential. The decision should include cost-effectiveness considerations.
  
  
  METHODS
  We constructed a cost-effectiveness analysis in the Dutch context, explicitly including risk of an outbreak. Outcomes from a dynamic transmission model, comparing an intervention with a non-intervention scenario, were input in our health economic calculations.
  
  
  RESULTS
  Stockpiling was cost-effective from the health-care perspective if the actual risk is 37% for 30 years. If less than 60% of the population would take the antiviral drugs or the attack rate is about 50%, the investment would not be cost-effective from this perspective.
  
  
  CONCLUSIONS
  Risk perception, realistic coverage among population and size of a pandemic are crucial parameters and highly decisive for the investment decision.
authors.affiliation: National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Epidemiology and Surveillance, Bilthoven, the Netherlands. anna.lugner@rivm.nl
authors.forename: Anna K
authors.initials: AK
authors.lastname: Lugnér
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000600:supply & distribution* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004196:Disease Outbreaks; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D008962:Models, Theoretical; D009426:Netherlands; D053139:Oseltamivir / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use; D018570:Risk Assessment
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir
references.citation: Emerg Infect Dis. 2006 Jan;12(1):95-102
references.pmid: 16494724
references.citation: CMAJ. 2003 Jan 7;168(1):49-56
references.pmid: 12515786
references.citation: PLoS One. 2007 May 02;2(5):e401
references.pmid: 17476323
references.citation: Emerg Infect Dis. 2006 Jan;12(1):15-22
references.pmid: 16494711
references.citation: Nature. 2006 Jul 27;442(7101):448-52
references.pmid: 16642006
references.citation: Arch Intern Med. 2003 Jul 28;163(14):1667-72
references.pmid: 12885681
references.citation: Vaccine. 2008 Jul 4;26(29-30):3742-9
references.pmid: 18524428
references.citation: Emerg Infect Dis. 2008 Feb;14(2):267-74
references.pmid: 18258120
references.citation: Science. 2009 Jun 19;324(5934):1557-61
references.pmid: 19433588
references.citation: Health Econ. 2010 May;19(5):518-31
references.pmid: 19382106
references.citation: Value Health. 2009 Mar-Apr;12(2):226-33
references.pmid: 18671770
references.citation: Vaccine. 2003 May 1;21(16):1762-8
references.pmid: 12686091
references.citation: Emerg Infect Dis. 2005 Aug;11(8):1280-2
references.pmid: 16102319
references.citation: PLoS Med. 2009 May 19;6(5):e1000085
references.pmid: 19440354
references.citation: Science. 2005 Aug 12;309(5737):1083-7
references.pmid: 16079251
references.citation: J Appl Microbiol. 2001 Oct;91(4):572-9
references.pmid: 11576290
references.citation: Proc Natl Acad Sci U S A. 2006 Apr 11;103(15):5935-40
references.pmid: 16585506
references.citation: Nature. 2005 Sep 8;437(7056):209-14
references.pmid: 16079797
references.citation: Value Health. 2003 Mar-Apr;6(2):116-25
references.pmid: 12641862
references.citation: Am J Epidemiol. 2006 Nov 15;164(10):936-44
references.pmid: 16968863
references.citation: Emerg Infect Dis. 2009 Jun;15(6):e1
references.pmid: 21970033
references.citation: Am J Hyg. 1958 Sep;68(2):190-212
references.pmid: 13571232
references.citation: Emerg Infect Dis. 2003 May;9(5):531-8
references.pmid: 12737735
references.citation: J Health Econ. 1995 Jun;14(2):171-89
references.pmid: 10154656
references.citation: Health Econ. 2008 Nov;17(11):1317-22
references.pmid: 18246542
references.citation: Euro Surveill. 2009 May 14;14(19):
references.pmid: 19442402