Purpose: Protective facewear (surgical masks and N-95 respirators) was used occasionally during the 2009 (H1N1) influenza pandemic. Stockpiling facewear may prevent infection during an influenza pandemic. Cost-effectiveness of stockpiling surgical masks or N-95 respirators for an influenza pandemic is unknown.
Method: We developed a dynamic transmission model of pandemic influenza to evaluate the effectiveness of the use of protective facewear in an urban setting. We used cost and disease transmission and progression data from the literature. We calculated societal costs and benefits of providing N-95 respirators to 80% of the population. We then calculated the societal costs and benefits of providing surgical masks instead. We measured outcomes in terms of intervention costs, treatment costs, total costs, infections, deaths, and quality adjusted life years (QALYs). All parameter assumptions were tested in sensitivity analysis.
Result: Under base case assumptions, stockpiling N-95 respirators would gain over 100,000 QALYs at a cost of $27,500 per QALY gained versus the status quo. Results are highly sensitive to the case-fatality proportion, respirator effectiveness, respirator compliance, and the utility decrement due to respirator use. If respirators are less than 50% effective at preventing transmission, they would be unlikely to be cost-effective. If effective, surgical masks could mitigate the pandemic with lower costs in both dollars and utility loss when compared to N-95 respirators. Conclusion: Stockpiling protective facewear for an influenza pandemic may be cost-effective, but it is sensitive to many assumptions. More research is needed to determine the effectiveness of surgical masks and N-95 respirators in preventing influenza transmission. Additional research on facewear compliance and its affect on quality of life would be valuable. 
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