December 2, 2020

Investing in pandemic preparedness

 The Cost Effectiveness of Stockpiling Drugs, Vaccines and Other Health Resources for Pandemic Preparedness

A short review on the topic, many questions, few answers. 

Health economics methods can be used to decide the optimal pandemic preparedness strategy based on cost effectiveness because different stockpiling of available measures can be implemented. The economic evaluation of pandemic preparedness strategies and pandemic preparedness measures is based on methods developed for health technology assessment. Nevertheless, this assessment differs from the traditional economic evaluations. The cost-effectiveness evaluation of a new drug compares healthcare costs and health effects for patients treated and not treated with the drug. The cost effectiveness of the drug will depend on the effectiveness of the drug in reducing clinical outcomes and healthcare costs. The drug will be used by the health system in patients with certainty. In contrast to this, the cost-effectiveness evaluation of pandemic preparedness measures and interventions is affected by several facts. First, pandemic preparedness measures are costly because they must be used to prevent and treat pandemic infections in a great number of persons. Second, investments in pandemic preparedness measures could be made many years before the emergence of the pandemic pathogen. Third, the health and economic benefits generated by pandemic preparedness measures will depend on the virulence and infectiousness of the pandemic pathogen. Fourth, pandemic preparedness measures can be associated with large costs and benefits outside the health system and great macroeconomics effects. There is a risk that an unknown pandemic agent will emerge and cause high morbidity and mortality, but we do not know when this will happen or how virulent and infectious a new pandemic agent will be. Although a new pandemic can be similar to previous pandemics, it can be also very different.

Ventilator support and intensive care for acute respiratory failure due to acute respiratory distress syndrome is a cost-effective intervention [8], but the cost effectiveness of stockpiling ventilators depends on the number of stockpiled ventilators and the severity of a future pandemic. The cost effectiveness of ventilator support and intensive care ranges from US$29,000 per QALY in low-risk patients (≥ 70% probability of surviving at least 2 months from the time of ventilator support) to US$110,000 per QALY in high-risk patients (prognostic estimate ≤ 50%) [7]. The question about the optimal number of stockpiling ventilators for pandemic preparedness depends on intervention costs and uncertainty about when the pandemic will happen and how virulent and infectious the pandemic pathogen will be.

Paul Strand at KBr