title: Systematic review of economic evaluations of preparedness strategies and interventions against influenza pandemics.
abstract: BACKGROUND
  Although public health guidelines have implications for resource allocation, these issues were not explicitly considered in previous WHO pandemic preparedness and response guidance. In order to ensure a thorough and informed revision of this guidance following the H1N1 2009 pandemic, a systematic review of published and unpublished economic evaluations of preparedness strategies and interventions against influenza pandemics was conducted.
  
  
  METHODS
  The search was performed in September 2011 using 10 electronic databases, 2 internet search engines, reference list screening, cited reference searching, and direct communication with relevant authors. Full and partial economic evaluations considering both costs and outcomes were included. Conversely, reviews, editorials, and studies on economic impact or complications were excluded. Studies were selected by 2 independent reviewers.
  
  
  RESULTS
  44 studies were included. Although most complied with the cost effectiveness guidelines, the quality of evidence was limited. However, the data sources used were of higher quality in economic evaluations conducted after the 2009 H1N1 pandemic. Vaccination and drug regimens were varied. Pharmaceutical plus non-pharmaceutical interventions are relatively cost effective in comparison to vaccines and/or antivirals alone. Pharmaceutical interventions vary from cost saving to high cost effectiveness ratios. According to ceiling thresholds (Gross National Income per capita), the reduction of non-essential contacts and the use of pharmaceutical prophylaxis plus the closure of schools are amongst the cost effective strategies for all countries. However, quarantine for household contacts is not cost effective even for low and middle income countries.
  
  
  CONCLUSIONS
  The available evidence is generally inconclusive regarding the cost effectiveness of preparedness strategies and interventions against influenza pandemics. Studies on their effectiveness and cost effectiveness should be readily implemented in forthcoming events that also involve the developing world. Guidelines for assessing the impact of disease and interventions should be drawn up to facilitate these studies.
authors.affiliation: Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Muang, Nonthaburi, Thailand. romanperezvelasco@gmail.com
authors.forename: Román
authors.initials: R
authors.lastname: Pérez Velasco
authors.forename: Naiyana
authors.initials: N
authors.lastname: Praditsitthikorn
authors.forename: Kamonthip
authors.initials: K
authors.lastname: Wichmann
authors.forename: Adun
authors.initials: A
authors.lastname: Mohara
authors.forename: Surachai
authors.initials: S
authors.lastname: Kotirum
authors.forename: Sripen
authors.initials: S
authors.lastname: Tantivess
authors.forename: Constanza
authors.initials: C
authors.lastname: Vallenas
authors.forename: Hande
authors.initials: H
authors.lastname: Harmanci
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
mesh_terms: D003140:Communicable Disease Control / Q000191:economics; D003362:Cost-Benefit Analysis; D003625:Data Collection; D003627:Data Interpretation, Statistical; D004189:Disaster Planning / Q000379:methods; D006801:Humans; D055552:Infectious Disease Medicine / Q000191:economics; D053118:Influenza A Virus, H1N1 Subtype / Q000378:metabolism; D007251:Influenza, Human / Q000191:economics* / Q000517:prevention & control*; D018803:Models, Economic; D058873:Pandemics / Q000191:economics*; D011634:Public Health