Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Muang, Nonthaburi, Thailand.
PLoS One. 2012;7(2):e30333. doi: 10.1371/journal.pone.0030333. Epub 2012 Feb 29.
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thorough and informed revision of this guidance following the H1N1 2009 pandemic, a systematic review of published and unpublished economic evaluations of preparedness strategies and interventions against influenza pandemics was conducted.
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.
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.
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.
尽管公共卫生指南对资源分配有影响，但在世界卫生组织之前的大流行防范和应对指南中并未明确考虑这些问题。为了确保在 H1N1 2009 大流行之后对该指南进行全面和知情的修订，我们对防范流感大流行的策略和干预措施的已发表和未发表的经济评估进行了系统回顾。
我们于 2011 年 9 月使用 10 个电子数据库、2 个互联网搜索引擎、参考文献筛选、引用参考文献搜索以及与相关作者的直接交流进行了搜索。包括考虑成本和结果的全面和部分经济评估。相反，排除了评论、社论和关于经济影响或并发症的研究。由 2 位独立审查员选择研究。
共纳入 44 项研究。尽管大多数研究符合成本效益指南，但证据质量有限。然而，在 2009 年 H1N1 大流行之后进行的经济评估中，所使用的数据来源质量更高。疫苗接种和药物方案各不相同。与单独使用疫苗和/或抗病毒药物相比，药物加非药物干预相对具有成本效益。药物干预从节省成本到高成本效益比不等。根据上限阈值（人均国民总收入），减少非必要接触以及使用药物预防加上关闭学校是所有国家都具有成本效益的策略。但是，对家庭接触者进行检疫即使对于中低收入国家也没有成本效益。
关于防范流感大流行的策略和干预措施的成本效益，现有证据通常没有定论。应在即将到来的事件中（也涉及发展中国家）迅速开展关于其有效性和成本效益的研究。应制定评估疾病和干预措施影响的指南，以促进这些研究。
