Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, H3143, Stanford, CA 94305, USA.
Ann Intern Med. 2009 Dec 15;151(12):840-53. doi: 10.7326/0003-4819-151-12-200912150-00156.
The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century.
To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies.
Compartmental epidemic model in conjunction with a Markov model of disease progression.
Literature and expert opinion.
Residents of a U.S. metropolitan city with a population of 8.3 million.
Lifetime.
Societal.
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.
Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.
RESULTS OF BASE-CASE ANALYSIS: 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.
Expanded vaccination remained incrementally cost-effective over a wide range of assumptions.
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.
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.
National Institutes of Health and Agency for Healthcare Research and Quality.
甲型流感（H5N1）病毒的大流行潜力是 21 世纪公共卫生的主要关注点。
评估替代大流行（H5N1）缓解和应对策略的有效性和成本效益。
结合疾病进展的马尔可夫模型的隔室流行模型。
文献和专家意见。
人口为 830 万的美国大都市居民。
终身。
社会。
3 种情景：1）类似于美国库存中目前可用的疫苗接种和抗病毒药物治疗（库存策略），2）库存策略，但扩大抗病毒药物的分发（扩大预防策略），3）库存策略，但使用佐剂疫苗（扩大疫苗接种策略）。所有情景均假设采用标准的非药物干预措施。
预防感染和死亡、成本、质量调整生命年（QALY）和增量成本效益。
与库存策略相比，扩大疫苗接种是 3 种策略中最有效和最具成本效益的策略，可预防 68%的感染和死亡，并获得 404030 个 QALY，每获得一个 QALY 的成本为 10844 美元。
在广泛的假设条件下，扩大疫苗接种仍然具有增量成本效益。
该模型假设病例和接触者的混合是同质的；异质混合将导致初始传播更快，随后传播速度更慢。我们没有为儿童或老年人建模干预措施；该模型不是为针对特定群体的干预措施而设计的。
扩大佐剂疫苗接种是应对甲型流感（H5N1）大流行的有效和具有成本效益的缓解策略。扩大抗病毒预防可以帮助延缓大流行，同时实施其他策略。
美国国立卫生研究院和医疗保健研究与质量局。
