Pasquini-Descomps Hélène, Brender Nathalie, Maradan David
Haute École de Gestion Genève (Geneva School of Business Administration), HES-SO University of Applied Sciences Western Switzerland, Carouge, Switzerland; University of Geneva, Switzerland.
Haute École de Gestion Genève (Geneva School of Business Administration), HES-SO University of Applied Sciences Western Switzerland, Carouge, Switzerland.
Value Health. 2017 Jun;20(6):819-827. doi: 10.1016/j.jval.2016.05.005. Epub 2016 Jun 29.
The 2009 A/H1N1 influenza pandemic generated additional data and triggered new studies that opened debate over the optimal strategy for handling a pandemic. The lessons-learned documents from the World Health Organization show the need for a cost estimation of the pandemic response during the risk-assessment phase. Several years after the crisis, what conclusions can we draw from this field of research?
The main objective of this article was to provide an analysis of the studies that present cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009 and to identify which measures seem most cost-effective.
We reviewed 18 academic articles that provide cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009. Our review converts the studies' results into a cost-utility measure (cost per disability-adjusted life-year or quality-adjusted life-year) and presents the contexts of severity and fatality.
The existing studies suggest that hospital quarantine, vaccination, and usage of the antiviral stockpile are highly cost-effective, even for mild pandemics. However, school closures, antiviral treatments, and social distancing may not qualify as efficient measures, for a virus like 2009's H1N1 and a willingness-to-pay threshold of $45,000 per disability-adjusted life-year. Such interventions may become cost-effective for severe crises.
This study helps to shed light on the cost-utility of various interventions, and may support decision making, among other criteria, for future pandemics. Nonetheless, one should consider these results carefully, considering these may not apply to a specific crisis or country, and a dedicated cost-effectiveness assessment should be conducted at the time.
2009年甲型H1N1流感大流行产生了更多数据，并引发了新的研究，这些研究引发了关于应对大流行的最佳策略的辩论。世界卫生组织的经验教训文件表明，在风险评估阶段需要对大流行应对措施进行成本估算。危机过去几年后，我们能从这个研究领域得出哪些结论呢？
本文的主要目的是分析自2009年以来对甲型H1N1流感大流行干预措施进行成本效益或成本效益分析的研究，并确定哪些措施似乎最具成本效益。
我们回顾了18篇自2009年以来对甲型H1N1流感大流行干预措施进行成本效益或成本效益分析的学术文章。我们的回顾将研究结果转化为成本效用指标（每伤残调整生命年或质量调整生命年的成本），并呈现了严重程度和死亡率的背景情况。
现有研究表明，即使对于轻度大流行，医院隔离、疫苗接种和抗病毒储备的使用也具有很高的成本效益。然而，对于像2009年的H1N1这样的病毒，以及每伤残调整生命年45000美元的支付意愿阈值，学校关闭、抗病毒治疗和社会 distancing（原文可能有误，推测为社交距离）可能不符合高效措施的标准。对于严重危机，此类干预措施可能会变得具有成本效益。
本研究有助于阐明各种干预措施的成本效用，并可能支持未来大流行决策等标准的制定。尽管如此，人们应仔细考虑这些结果，因为这些结果可能不适用于特定危机或国家，届时应进行专门的成本效益评估。
