应对流行性呼吸道病毒威胁，控制医院感染的成本效益分析

潮水

emerging infectious disease
Volume 15, Number 12–December 2009
Cost-effectiveness Analysis of Hospital Infection Control Response to an Epidemic Respiratory Virus Threat
Abstract
The outbreak of influenza A pandemic (H1N1) 2009 prompted many countries in Asia, previously strongly affected by severe acute respiratory syndrome (SARS), to respond with stringent measures, particularly in preventing outbreaks in hospitals. We studied actual direct costs and cost-effectiveness of different response measures from a hospital perspective in tertiary hospitals in Singapore by simulating outbreaks of SARS, pandemic (H1N1) 2009, and 1918 Spanish influenza. Protection measures targeting only infected patients yielded lowest incremental cost/death averted of $23,000 (US$) for pandemic (H1N1) 2009. Enforced protection in high-risk areas (Yellow Alert) and full protection throughout the hospital (Orange Alert) averted deaths but came at an incremental cost of up to $2.5 million/death averted. SARS and Spanish influenza favored more stringent measures. High case-fatality rates, virulence, and high proportion of atypical manifestations impacted cost-effectiveness the most. A calibrated approach in accordance with viral characteristics and community risks may help refine responses to future epidemics.

应对流行性呼吸道病毒威胁，控制医院感染的成本效益分析//Yock Young Dan, Paul A. Tambyah, Joe Sim，等  2009年甲型H1N1流感暴发促使许多曾深受SARS之害的亚洲国家采取了严格的应对措施，尤其是在预防医院感染暴发方面。我们在新加坡三级医院通过模拟SARS、2009年甲型H1N1流感和1918年的西班牙流感暴发三种模式，研究了医院方面不同应对措施的实际成本和成本效益分析。2009年甲型H1N1流感大流行中，保护措施仅针对病毒感染者，为避免死亡产生的边际成本最低，仅为$23 000；高危地区的加强防护措施（黄色警戒）和整个医院全面防护措施（橙色警戒）避免了病例死亡，但为避免死亡产生的边际成本高达$2，500，000。SARS和西班牙流感需要更严格的措施。高病死率、高毒力和高比例的不典型症状对成本/效益的影响最大。根据病毒特征和社区风险调整措施有助于更好地应对未来的疾病流行。

潮水

见全文