Investment decisions in influenza pandemic contingency planning: cost-effectiveness of stockpiling antiviral drugs.
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.
Lugnér
Anna K
AK
National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Epidemiology and Surveillance, Bilthoven, the Netherlands. anna.lugner@rivm.nl
Postma
Maarten J
MJ
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
D000998:Antiviral Agents; D053139:Oseltamivir
Emerg Infect Dis. 2006 Jan;12(1):95-102
16494724
CMAJ. 2003 Jan 7;168(1):49-56
12515786
PLoS One. 2007 May 02;2(5):e401
17476323
Emerg Infect Dis. 2006 Jan;12(1):15-22
16494711
Nature. 2006 Jul 27;442(7101):448-52
16642006
Arch Intern Med. 2003 Jul 28;163(14):1667-72
12885681
Vaccine. 2008 Jul 4;26(29-30):3742-9
18524428
Emerg Infect Dis. 2008 Feb;14(2):267-74
18258120
Science. 2009 Jun 19;324(5934):1557-61
19433588
Health Econ. 2010 May;19(5):518-31
19382106
Value Health. 2009 Mar-Apr;12(2):226-33
18671770
Vaccine. 2003 May 1;21(16):1762-8
12686091
Emerg Infect Dis. 2005 Aug;11(8):1280-2
16102319
PLoS Med. 2009 May 19;6(5):e1000085
19440354
Science. 2005 Aug 12;309(5737):1083-7
16079251
J Appl Microbiol. 2001 Oct;91(4):572-9
11576290
Proc Natl Acad Sci U S A. 2006 Apr 11;103(15):5935-40
16585506
Nature. 2005 Sep 8;437(7056):209-14
16079797
Value Health. 2003 Mar-Apr;6(2):116-25
12641862
Am J Epidemiol. 2006 Nov 15;164(10):936-44
16968863
Emerg Infect Dis. 2009 Jun;15(6):e1
21970033
Am J Hyg. 1958 Sep;68(2):190-212
13571232
Emerg Infect Dis. 2003 May;9(5):531-8
12737735
J Health Econ. 1995 Jun;14(2):171-89
10154656
Health Econ. 2008 Nov;17(11):1317-22
18246542
Euro Surveill. 2009 May 14;14(19):
19442402