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Economic Analysis of Pandemic Influenza Vaccination Strategies in Singapore

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  • Vernon J Lee
  • Mei Yin Tok
  • Vincent T Chow
  • Kai Hong Phua
  • Eng Eong Ooi
  • Paul A Tambyah
  • Mark I Chen

Abstract

Background: All influenza pandemic plans advocate pandemic vaccination. However, few studies have evaluated the cost-effectiveness of different vaccination strategies. This paper compares the economic outcomes of vaccination compared with treatment with antiviral agents alone, in Singapore. Methodology: We analyzed the economic outcomes of pandemic vaccination (immediate vaccination and vaccine stockpiling) compared with treatment-only in Singapore using a decision-based model to perform cost-benefit and cost-effectiveness analyses. We also explored the annual insurance premium (willingness to pay) depending on the perceived risk of the next pandemic occurring. Principal Findings: The treatment-only strategy resulted in 690 deaths, 13,950 hospitalization days, and economic cost of USD$497 million. For immediate vaccination, at vaccine effectiveness of >55%, vaccination was cost-beneficial over treatment-only. Vaccine stockpiling is not cost-effective in most scenarios even with 100% vaccine effectiveness. The annual insurance premium was highest with immediate vaccination, and was lower with increased duration to the next pandemic. The premium was also higher with higher vaccine effectiveness, attack rates, and case-fatality rates. Stockpiling with case-fatality rates of 0.4–0.6% would be cost-beneficial if vaccine effectiveness was >80%; while at case-fatality of >5% stockpiling would be cost-beneficial even if vaccine effectiveness was 20%. High-risk sub-groups warrant higher premiums than low-risk sub-groups. Conclusions: The actual pandemic vaccine effectiveness and lead time is unknown. Vaccine strategy should be based on perception of severity. Immediate vaccination is most cost-effective, but requires vaccines to be available when required. Vaccine stockpiling as insurance against worst-case scenarios is also cost-effective. Research and development is therefore critical to develop and stockpile cheap, readily available effective vaccines.

Suggested Citation

  • Vernon J Lee & Mei Yin Tok & Vincent T Chow & Kai Hong Phua & Eng Eong Ooi & Paul A Tambyah & Mark I Chen, 2009. "Economic Analysis of Pandemic Influenza Vaccination Strategies in Singapore," PLOS ONE, Public Library of Science, vol. 4(9), pages 1-8, September.
    • Handle: RePEc:plo:pone00:0007108
    DOI: 10.1371/journal.pone.0007108
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    References listed on IDEAS

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    1. Steven Riley & Joseph T Wu & Gabriel M Leung, 2007. "Optimizing the Dose of Pre-Pandemic Influenza Vaccines to Reduce the Infection Attack Rate," PLOS Medicine, Public Library of Science, vol. 4(6), pages 1-9, June.
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    RePEc Biblio mentions

    As found on the RePEc Biblio, the curated bibliography for Economics:
    1. > Economics of Welfare > Health Economics > Economics of Pandemics > Policy responses > Vaccination

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    Cited by:

    1. Román Pérez Velasco & Naiyana Praditsitthikorn & Kamonthip Wichmann & Adun Mohara & Surachai Kotirum & Sripen Tantivess & Constanza Vallenas & Hande Harmanci & Yot Teerawattananon, 2012. "Systematic Review of Economic Evaluations of Preparedness Strategies and Interventions against Influenza Pandemics," PLOS ONE, Public Library of Science, vol. 7(2), pages 1-9, February.
    2. Henry H. Willis & Melinda Moore, 2014. "Improving the Value of Analysis for Biosurveillance," Decision Analysis, INFORMS, vol. 11(1), pages 63-81, March.
    3. Pedro, S.A. & Rwezaura, H. & Mandipezar, A. & Tchuenche, J.M., 2021. "Qualitative Analysis of an influenza model with biomedical interventions," Chaos, Solitons & Fractals, Elsevier, vol. 146(C).
    4. George J Milne & Nilimesh Halder & Joel K Kelso, 2013. "The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-16, April.

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