Simulating school closure policies for cost effective pandemic decision making.
BACKGROUND
Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life.


METHODS
Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP) and closure durations.


RESULTS
Assuming a willingness to pay per quality adjusted life-year (QALY) threshold equal to the US per capita GDP ($46,000), we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP) with the longest duration closure (24 weeks) considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates).


CONCLUSIONS
These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic.
College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA. ozgur.araz@unmc.edu
Ozgur M
OM
Araz
Paul
P
Damien
David A
DA
Paltiel
Sean
S
Burke
Bryce
B
van de Geijn
Alison
A
Galvani
Lauren Ancel
LA
Meyers
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006291:Health Policy / Q000191:economics*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000191:economics / Q000453:epidemiology*; D018803:Models, Economic; D008962:Models, Theoretical; D058873:Pandemics / Q000191:economics / Q000517:prevention & control*; D012574:Schools / Q000191:economics / Q000458:organization & administration*; D013781:Texas / Q000453:epidemiology; D055815:Young Adult