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Monday, 18 October 2004 - 12:00 PM

This presentation is part of: Oral Concurrrent Session A - Public Health 1

THE COST EFFECTIVENESS OF ALTERNATIVE STRATEGIES FOR STOCKPILING AND DISPENSING MEDICAL AND PHARMACEUTICAL SUPPLIES FOR A RESPONSE TO ANTHRAX BIOTERRORISM

Dena M. Bravata, MD, MS1, Gregory S. Zaric, PhD2, Jon-Erik C. Holty, MD1, Margaret L. Brandeau3, Emilee R. Wilhelm, BA1, Kathryn M. McDonald, MM1, and Douglas K. Owens, MD, MS4. (1) Stanford University, Center for Primary Care and Outcomes Research, Stanford, CA, (2) University of Western Ontario, Ivey School of Business, London, ON, Canada, (3) Stanford University, Management Science and Engineering, Stanford, CA, (4) VA Palo Alto Healthcare System, Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA

Purpose: There is an ongoing national debate regarding appropriate strategies for regionalization of medical and pharmaceutical supplies for bioterrorism responses. We developed a simulation model to evaluate the health benefits, costs, and cost effectiveness for changes in the levels of local inventories, delays in the arrival of regional inventories, and changes in the local capacity to dispense inventories.

Methods: We simulated an aerosol release of anthrax spores in a US metropolitan area, varying the exposed population from 50,000 to 250,000 and the number seeking prophylaxis from 100,000 to 5 million. Our disease progression model, based on 60 cases of inhalational anthrax, included three disease stages: asymptomatic incubation, prodromal, and fulminant. Based on the literature, the base case assumed attack detection within 48 hours, local inventories containing 64,500 person-days of prophylaxis and 781 person-days of treatment, a regional inventory containing 2,450,000 person-days of prophylaxis and 4,000 person-days of treatment would be available for dispensing 12 hours after attack detection, additional regional inventories would be available for dispensing 36 hours after attack detection, the local capacity to dispense prophylactic antibioics was 1,400 individuals/hour, and 64% of individuals were fully adherent with prophylaxis regimens.

Results: We found that mortality was highly dependent on the number of individuals requiring prophylaxis, dispensing capacity, adherence with prophylactic antibiotics, and delays in attack detection. For an attack that exposed 250,000 people and required the prophylaxis of 5 million, the expected mortality fell from 240,575 to 157,738 as the dispensing capacity increased from 1,400 to 22,500 individuals per hour. At low dispensing capacities (< base case), nearly all exposed individuals died, regardless of the rate of adherence with prophylaxis. At higher dispensing capacities, the expected mortality was dependent on the rate of adherence with prophylactic antibiotics. There was no benefit to doubling the local inventory at low dispensing capacities; however, at higher dispensing capacities, the cost effectiveness of doubling local inventories fell from $43,628 to $373/QALY as the annual probability of an attack increased from 0.0001 to 0.01.

Conclusions: Because of the rapid availability of regional inventories, the critical determinant of mortality following anthrax bioterrorism is local dispensing capacity. Bioterrorism preparedness efforts directed at improving local dispensing capacity may yield greater benefits than stockpiling and maintaining local inventories.


See more of Oral Concurrrent Session A - Public Health 1
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)