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.
See more of: The 32nd Annual Meeting of the Society for Medical Decision Making