title: Cost-effectiveness analysis of hospital infection control response to an epidemic respiratory virus threat.
abstract: The outbreak of influenza A pandemic (H1N1) 2009 prompted many countries in Asia, previously strongly affected by severe acute respiratory syndrome (SARS), to respond with stringent measures, particularly in preventing outbreaks in hospitals. We studied actual direct costs and cost-effectiveness of different response measures from a hospital perspective in tertiary hospitals in Singapore by simulating outbreaks of SARS, pandemic (H1N1) 2009, and 1918 Spanish influenza. Protection measures targeting only infected patients yielded lowest incremental cost/death averted of 23,000 (US dollars) for pandemic (H1N1) 2009. Enforced protection in high-risk areas (Yellow Alert) and full protection throughout the hospital (Orange Alert) averted deaths but came at an incremental cost of up to $2.5 million/death averted. SARS and Spanish influenza favored more stringent measures. High case-fatality rates, virulence, and high proportion of atypical manifestations impacted cost-effectiveness the most. A calibrated approach in accordance with viral characteristics and community risks may help refine responses to future epidemics.
authors: National University Health System, Singapore.
authors: Yock Young
authors: YY
authors: Dan
authors: Paul A
authors: PA
authors: Tambyah
authors: Joe
authors: J
authors: Sim
authors: Jeremy
authors: J
authors: Lim
authors: Li Yang
authors: LY
authors: Hsu
authors: Wai Leng
authors: WL
authors: Chow
authors: Dale A
authors: DA
authors: Fisher
authors: Yue Sie
authors: YS
authors: Wong
authors: Khek Yu
authors: KY
authors: Ho
mesh_terms: D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control*; D004196:Disease Outbreaks; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control; D008390:Markov Chains; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D012846:Singapore