Key Point

Based on a mathematical model, stockpiling antiviral medications for use during influenza pandemics is clearly cost-beneficial even when the model uses very conservative assumptions of pandemic probability and antiviral drug prices.

BE’ER-SHEVA, ISRAEL—Although the World Health Organization encourages the stockpiling of antiviral drugs for potential influenza pandemics, there is not much information about the cost-benefit of such a strategy. But if the results of a recent study are any indication, stockpiling would probably be wise.¹

“We found that for every dollar invested in stockpiling, we can expect to save more than $3.50 even if we assume only one pandemic every 33 years, and this investment remains cost-saving even if only one pandemic occurs every 80 years,” lead author Ran D. Balicer, MD, told Pulmonary Reviews. However, whether savings occurred depended on how antiviral stockpiles were used. While long-term preexposure prophylaxis was not shown to be cost-effective, both treatment of influenza cases and postexposure prophylaxis appeared to be cost-saving strategies.

“Importantly, our analysis did not include the value of life lost,” said Dr. Balicer, an Epidemiologist at the Ministry of Health in Jerusalem. “If it had, the cost-benefit ratios we reported would have been about six times higher.”

In a mathematical model, the authors calculated the health-related and economic costs of an unchecked influenza pandemic on the Israeli population. Then they factored in the impact of managing the pandemic through long-term preexposure oseltamivir prophylaxis, oseltamivir treatment of all influenza cases, and short-term postexposure prophylaxis for index cases and their close contacts.

“[A] pandemic would result in an estimated 1,618,200 patients (about 25% of the Israeli population), 781,921 physician visits, 10,334 hospitalizations, 2,855 deaths, and 6,536,240 lost workdays,” the authors reported. “These outcomes would result in an excess of $55.4 million in health-related costs and in overall costs to the economy of $523.5 million (about 0.5% of the Israeli gross domestic product).”

In terms of overall economic costs, long-term preexposure prophylaxis provided no cost-benefit, whether it was population-wide or limited to high-risk patients. However, oseltamivir treatment of all influenza cases, the treatment of high-risk patients only, and short-term postexposure prophylaxis yielded cost-benefit ratios of 2.44 ($2.44 for every dollar spent), 3.68, and 2.49, respectively.

Regarding direct health care costs, only the treatment of high-risk patients produced savings, as shown by a cost-benefit ratio of 1.51. Antiviral stockpiling was found to be cost-efficient even if the probability of an influenza pandemic was as low as one pandemic every 80 years and oseltamivir prices more than tripled.

“For our analysis, we deliberately chose conservative parameters to knowingly reach an underestimate of the cost-benefit of antiviral stockpiling,” Dr. Balicer said. “Even with all of our conservative assumptions, it still proved a very worthwhile investment.”

—Timothy Begany

Reference
1. Balicer RD, Huerta M, Davidovitch N, Grotto I. Cost-benefit of stockpiling drugs for influenza pandemic. Emerg Infect Dis. 2005;11:1280-1282.

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