Pharmaceutical interventions for mitigating an influenza pandemic: modeling the risks and health-economic impacts

Abstract

Model-based analyses built on burden-of-disease and cost–effectiveness theory predict that pharmaceutical interventions may efficiently mitigate both the epidemiologic and economic impact of an influenza pandemic. Pharmaceutical interventions typically encompass the application of (pre)pandemic influenza vaccines, other vaccines (notably pneumococcal), antiviral treatments and other drug treatment (e.g., antibiotics to target potential complications of influenza). However, these models may be too limited to capture the full macro-economic impact of pandemic influenza. The aim of this article is to summarize current health-economic modeling approaches to recognize the strengths and weaknesses of these approaches, and to compare these with more recently proposed alternative methods. We conclude that it is useful, particularly for policy and planning purposes, to extend modeling concepts through the application of alternative approaches, including insurers’ risk theories, human capital approaches and sectoral and full macro-economic modeling. This article builds on a roundtable meeting of the Pandemic Influenza Economic Impact Group that was held in Boston, MA, USA, in December 2008.

Keywords::

• cost–effectiveness analysis
• economic impact
• pandemic influenza

Contributors

All authors participated in the development and drafting of the manuscript, and saw and approved the final version.

Financial & competing interests disclosure

Maarten J Postma has received funding and support from GlaxoSmithKline, Hoffmann La-Roche, Sanofi Pasteur MSD and Wyeth for various projects into the cost–effectiveness of vaccination (and treatment) for (pandemic) influenza and other vaccine-based interventions, including pneumococcal and respiratory syncytial virus vaccinations. E Anthony S Nelson has received funding and support from Merck and Wyeth for diarrheal and respiratory disease surveillance studies, has participated in vaccine studies funded by Baxter, GlaxoSmithKline, MedImmune and Wyeth and has received lecture fees and travel support from GlaxoSmithKline, Merck, Intercell and Wyeth. Richard Coker has received funding and support from Hoffmann La-Roche for research on health systems and influenza and received honoraria and travel support from Hoffmann La-Roche and GlaxoSmithKline. George Milne has received honoraria and travel support from GlaxoSmithKline. John Oxford has received lecture honorarium and travel support from Baxter, GlaxoSmithKline, Roche and Novartis. Bruce Pyenson has worked on engagements related to pandemic influenza for GlaxoSmithKline; Milliman, Inc. is an actuarial consulting firm engaged by a broad spectrum of government entities, private companies, insurers, and pharmaceutical companies. Louis P Garrison has consulted for Roche Pharmaceuticals and Adamas Pharmaceuticals. All authors received support from GlaxoSmithKline to attend an expert roundtable meeting on which the present manuscript is based. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial support was provided by Jon Ruddick (Litmus MME, London, UK). GlaxoSmithKline Biologicals was the funding source of the publication costs and the expert roundtable from which the publication was developed but did not contribute to, nor review the content of the manuscript.