title: Economic Evaluation of Individual School Closure Strategies: The Hong Kong 2009 H1N1 Pandemic.
abstract: BACKGROUND
  School closures as a means of containing the spread of disease have received considerable attention from the public health community. Although they have been implemented during previous pandemics, the epidemiological and economic effects of the closure of individual schools remain unclear.
  
  
  METHODS
  This study used data from the 2009 H1N1 pandemic in Hong Kong to develop a simulation model of an influenza pandemic with a localised population structure to provide scientific justifications for and economic evaluations of individual-level school closure strategies.
  
  
  RESULTS
  The estimated cost of the study's baseline scenario was USD330 million. We found that the individual school closure strategies that involved all types of schools and those that used a lower threshold to trigger school closures had the best performance. The best scenario resulted in an 80% decrease in the number of cases (i.e., prevention of about 830,000 cases), and the cost per case prevented by this intervention was USD1,145; thus, the total cost was USD1.28 billion.
  
  
  CONCLUSIONS
  This study predicts the effects of individual school closure strategies on the 2009 H1N1 pandemic in Hong Kong. Further research could determine optimal strategies that combine various system-wide and district-wide school closures with individual school triggers across types of schools. The effects of different closure triggers at different phases of a pandemic should also be examined.
authors.affiliation: School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Zoie Shui-Yee
authors.initials: ZS
authors.lastname: Wong
authors.affiliation: School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Goldsman
authors.affiliation: Department of Systems Engineering and Engineering Management, City University of Hong Kong, Hong Kong, China.
authors.forename: Kwok-Leung
authors.initials: KL
authors.lastname: Tsui
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D003140:Communicable Disease Control; D003362:Cost-Benefit Analysis; D006723:Hong Kong / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D058873:Pandemics; D011634:Public Health; D012574:Schools / Q000191:economics; D012680:Sensitivity and Specificity
references.citation: Epidemiol Infect. 2008 Jun;136(6):813-22
references.pmid: 17634160
references.citation: Stat Methods Med Res. 2015 Dec;24(6):615-34
references.pmid: 21930515
references.citation: PLoS One. 2011;6(7):e22087
references.pmid: 21760957
references.citation: Health Econ. 2004 May;13(5):405-15
references.pmid: 15127421
references.citation: Sci Rep. 2014;4:7218
references.pmid: 25427621
references.citation: Proc Natl Acad Sci U S A. 2007 May 1;104(18):7588-93
references.pmid: 17416677
references.citation: PLoS One. 2011;6(12):e29640
references.pmid: 22242138
references.citation: BMC Infect Dis. 2014;14:207
references.pmid: 24739814
references.citation: BMC Infect Dis. 2010;10:221
references.pmid: 20659348
references.citation: Proc Natl Acad Sci U S A. 2007 May 1;104(18):7582-7
references.pmid: 17416679
references.citation: BMC Public Health. 2008;8:61
references.pmid: 18275603
references.citation: PLoS One. 2014;9(5):e97297
references.pmid: 24830407
references.citation: Epidemiol Infect. 2008 Feb;136(2):166-79
references.pmid: 17445311
references.citation: Influenza Other Respir Viruses. 2009 Sep;3(5):215-22
references.pmid: 19702583
references.citation: J Stat Theory Pract. 2012;6(3):428-442
references.pmid: 23441022
references.citation: BMC Public Health. 2011;11 Suppl 1:S1
references.pmid: 21356128
references.citation: Emerg Infect Dis. 2009 Jan;15(1):137-8, author reply 138
references.pmid: 19116082
references.citation: Epidemiology. 2010 Nov;21(6):842-6
references.pmid: 20805752
references.citation: PLoS Med. 2011 Oct;8(10):e1001103
references.pmid: 21990967
references.citation: Clin Infect Dis. 2010 Dec 15;51(12):1370-9
references.pmid: 21067351
references.citation: Emerg Infect Dis. 2010 Mar;16(3):538-41
references.pmid: 20202441
references.citation: Hong Kong Med J. 2009 Oct;15 Suppl 6:44-7
references.pmid: 19801718
references.citation: Clin Infect Dis. 2010 Jan 15;50(2):165-74
references.pmid: 20021259
references.citation: Emerg Infect Dis. 1999 Sep-Oct;5(5):659-71
references.pmid: 10511522
references.citation: Clin Infect Dis. 2010 Nov 15;51(10):1184-91
references.pmid: 20964521
references.citation: N Engl J Med. 2010 Jun 10;362(23):2175-84
references.pmid: 20558368
references.citation: Health Econ. 2004 Mar;13(3):203-26
references.pmid: 14981647
references.citation: Emerg Infect Dis. 2007 Apr;13(4):581-9
references.pmid: 17553273
references.citation: Emerg Infect Dis. 2006 Jan;12(1):81-7
references.pmid: 16494722
references.citation: J Public Health Manag Pract. 2010 May-Jun;16(3):252-61
references.pmid: 20035236