Investment decisions in influenza pandemic contingency planning: Cost-effectiveness of stockpiling antiviral drugs

Abstract

Background: The threat of an influenza pandemic has led to stockpiling of antiviral drugs in order to mitigate a plausible outbreak. If the stockpile would be used in relation to the recent pandemic alert, an investment decision about renewing the stock for a possible subsequent pandemic is essential. The decision should include cost-effectiveness considerations. Methods: We constructed a cost-effectiveness analysis in the Dutch context, explicitly including risk of an outbreak. Outcomes from a dynamic transmission model, comparing an intervention with a non-intervention scenario, were input in our health economic calculations. Results: Stockpiling was cost-effective from the health-care perspective if the actual risk is 37 for 30 years. If less than 60 of the population would take the antiviral drugs or the attack rate is about 50, the investment would not be cost-effective from this perspective. Conclusion: Risk perception, realistic coverage among population and size of a pandemic are crucial parameters and highly decisive for the investment decision.