Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Clin Infect Dis. 2010 Jan 15;50(2):165-74. doi: 10.1086/649867.
The optimal community-level approach to control pandemic influenza is unknown.
We estimated the health outcomes and costs of combinations of 4 social distancing strategies and 2 antiviral medication strategies to mitigate an influenza pandemic for a demographically typical US community. We used a social network, agent-based model to estimate strategy effectiveness and an economic model to estimate health resource use and costs. We used data from the literature to estimate clinical outcomes and health care utilization.
At 1% influenza mortality, moderate infectivity (R(o) of 2.1 or greater), and 60% population compliance, the preferred strategy is adult and child social distancing, school closure, and antiviral treatment and prophylaxis. This strategy reduces the prevalence of cases in the population from 35% to 10%, averts 2480 cases per 10,000 population, costs $2700 per case averted, and costs $31,300 per quality-adjusted life-year gained, compared with the same strategy without school closure. The addition of school closure to adult and child social distancing and antiviral treatment and prophylaxis, if available, is not cost-effective for viral strains with low infectivity (R(o) of 1.6 and below) and low case fatality rates (below 1%). High population compliance lowers costs to society substantially when the pandemic strain is severe (R(o) of 2.1 or greater).
Multilayered mitigation strategies that include adult and child social distancing, use of antivirals, and school closure are cost-effective for a moderate to severe pandemic. Choice of strategy should be driven by the severity of the pandemic, as defined by the case fatality rate and infectivity.
控制大流行性流感的最佳社区级方法尚不清楚。
我们估计了 4 种社会隔离策略和 2 种抗病毒药物策略的组合对减轻美国典型社区流感大流行的健康结果和成本。我们使用社会网络、基于代理的模型来估计策略效果，使用经济模型来估计卫生资源的使用和成本。我们使用文献中的数据来估计临床结果和医疗保健利用情况。
在流感死亡率为 1%、中等传染性（R(o)大于 2.1）和 60%人口遵从性的情况下，首选策略是成人和儿童社会隔离、学校关闭以及抗病毒治疗和预防。与没有学校关闭的相同策略相比，该策略可将人群中的病例流行率从 35%降低到 10%，避免每 10000 人中出现 2480 例病例，每例病例的成本为 2700 美元，每获得 1 个质量调整生命年的成本为 31300 美元。如果可获得，则在成人和儿童社会隔离以及抗病毒治疗和预防的基础上增加学校关闭，对于传染性较低（R(o)为 1.6 及以下）和病死率较低（低于 1%）的病毒株，并不具有成本效益。当大流行株严重（R(o)为 2.1 或更高）时，高人群遵从性可大大降低社会成本。
包括成人和儿童社会隔离、使用抗病毒药物和学校关闭的多层缓解策略对于中度至重度大流行是具有成本效益的。策略的选择应根据大流行的严重程度（由病死率和传染性定义）来决定。
