title: Effectiveness and cost-effectiveness of expanded antiviral prophylaxis and adjuvanted vaccination strategies for an influenza A (H5N1) pandemic.
abstract: BACKGROUND
  The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century.
  
  
  OBJECTIVE
  To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies.
  
  
  METHODS
  Compartmental epidemic model in conjunction with a Markov model of disease progression.
  
  
  METHODS
  Literature and expert opinion.
  
  
  METHODS
  Residents of a U.S. metropolitan city with a population of 8.3 million.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  3 scenarios: 1) vaccination and antiviral pharmacotherapy in quantities similar to those currently available in the U.S. stockpile (stockpiled strategy), 2) stockpiled strategy but with expanded distribution of antiviral agents (expanded prophylaxis strategy), and 3) stockpiled strategy but with adjuvanted vaccine (expanded vaccination strategy). All scenarios assumed standard nonpharmaceutical interventions.
  
  
  METHODS
  Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.
  
  
  RESULTS
  Expanded vaccination was the most effective and cost-effective of the 3 strategies, averting 68% of infections and deaths and gaining 404 030 QALYs at $10 844 per QALY gained relative to the stockpiled strategy.
  
  
  RESULTS
  Expanded vaccination remained incrementally cost-effective over a wide range of assumptions.
  
  
  CONCLUSIONS
  The model assumed homogenous mixing of cases and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. We did not model interventions for children or older adults; the model is not designed to target interventions to specific groups.
  
  
  CONCLUSIONS
  Expanded adjuvanted vaccination is an effective and cost-effective mitigation strategy for an influenza A (H5N1) pandemic. Expanded antiviral prophylaxis can help delay the pandemic while additional strategies are implemented.
  
  
  BACKGROUND
  National Institutes of Health and Agency for Healthcare Research and Quality.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3143, Stanford, CA 94305, USA.
authors.forename: Nayer
authors.initials: N
authors.lastname: Khazeni
authors.forename: David W
authors.initials: DW
authors.lastname: Hutton
authors.forename: Alan M
authors.initials: AM
authors.lastname: Garber
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
mesh_terms: D000276:Adjuvants, Immunologic / Q000191:economics*; D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017589:Immunization Programs; D053124:Influenza A Virus, H5N1 Subtype; D007252:Influenza Vaccines / Q000009:adverse effects / Q000191:economics* / Q000600:supply & distribution; D007251:Influenza, Human / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008390:Markov Chains; D032541:Mass Vaccination / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
chemical_list: D000276:Adjuvants, Immunologic; D000998:Antiviral Agents; D007252:Influenza Vaccines