Modeling the economic impact of pandemic influenza: a case study in Turkey

What can we learn from historical pandemics? A systematic review of the literature

What are the insights from historical pandemics for policymaking today? We carry out a systematic review of the literature on the impact of pandemics that occurred since the Industrial Revolution and prior to Covid-19. Our literature searches were conducted between June 2020 and September 2023, with the final review encompassing 169 research papers selected for their relevance to understanding either the demographic or economic impact of pandemics. We include literature from across disciplines to maximise our knowledge base, finding many relevant articles in journals which would not normally be on the radar of social scientists. Our review identifies two gaps in the literature: (1) the need to study pandemics and their effects more collectively rather than looking at them in isolation; and (2) the need for more study of pandemics besides 1918 Spanish Influenza, especially milder pandemic episodes. These gaps are a consequence of academics working in silos, failing to draw on the skills and knowledge offered by other disciplines. Synthesising existing knowledge on pandemics in one place provides a basis upon which to identify the lessons in preparing for future catastrophic disease events.

Economic impact of acute respiratory disease pandemics: A scoping review

Background

The economic impact of acute respiratory disease pandemics has yet to be specifically systematically reviewed. The aim of this scoping review is to identify and classify the economic impacts and its values and ranges.

Materials and Methods

We conducted a literature search across three key databases using an extensive list of keywords. Then, we included studies which explored direct and indirect costs as well as broader economic impact associated with different nine acute respiratory diseases, i.e., pandemic and seasonal influenza, avian influenza, equine influenza, swine influenza, severe acute respiratory syndrome, coronavirus disease 2019, Middle East respiratory syndrome, H1N1, and H7N9.

Results

We included 62 studies in English language between 1987 and 2020, mostly from the countries of East Asia and Pacific pertinent. We classified the economic impact into 5 main categories and 18 subcategories. The main categories were macroeconomic impacts, impacts on health cost, industry, businesses and trade, and education.

Conclusion

Respiratory disease pandemics have widely impacted different sectors of economy such as the direct cost on macroeconomic, providing and receiving health services, disease management, industries, business and trade, education, and indirect costs due to productivity losses. However, lots of the reviewed studies were unable to quantify the actual economic cost of these impacts. This made it challenging to conduct any kind of quantitative comparison of the results. A key priority for future research is to develop standard methods to quantify the broader economic costs of respiratory disease pandemics. Understanding the total economic impact of respiratory disease pandemics is a key step to inform national and international priority setting for disease prevention and pandemic control interventions.

Vaccinating healthcare workers: Level of implementation, barriers and proposal for evidence-based policies in Turkey

The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets. The obstacles to getting vaccinated or recommending vaccination may include rather universal factors such as the vaccine paradox, however in the case of HCWs, probably a different set of factors are included. The aims of this article are to gain an overview of vaccination strategies for HCWs, to assess the coverage rates of HCWs and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey and to compare them with the global picture to improve implementation of policies concerning vaccination of HCWs.

Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey

Objective

In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%.

Methods

A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza.

Results

Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective.

Conclusions

Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective.

Influenza vaccines in low and middle income countries: a systematic review of economic evaluations

OBJECTIVES

Economic evaluations on influenza vaccination from low resource settings are scarce and have not been evaluated using a systematic approach. Our objective was to conduct a systematic review on the value for money of influenza vaccination in low- and middle-income countries.

METHODS

PubMed and EMBASE were searched for economic evaluations published in any language between 1960 and 2011. Main outcome measures were costs per influenza outcome averted, costs per quality-adjusted life years gained or disability-adjusted life years averted, costs per benefit in monetary units or cost-benefit ratios.

RESULTS

Nine economic evaluations on seasonal influenza vaccine met the inclusion criteria. These were model- or randomized-controlled-trial (RCT)-based economic evaluations from middle-income countries. Influenza vaccination provided value for money for elderly, infants, adults and children with high-risk conditions. Vaccination was cost-effective and cost-saving for chronic obstructive pulmonary disease patients and in elderly above 65 y from model-based evaluations, but conclusions from RCTs on elderly varied.

CONCLUSION

Economic evaluations from middle income regions differed in population studied, outcomes and definitions used. Most findings are in line with evidence from high-income countries highlighting that influenza vaccine is likely to provide value for money. However, serious methodological limitations do not allow drawing conclusions on cost-effectiveness of influenza vaccination in middle income countries. Evidence on cost-effectiveness from low-income countries is lacking altogether, and more information is needed from full economic evaluations that are conducted in a standardized manner.

The integrated information architecture: a pilot study approach to leveraging logistics management with regard to influenza preparedness

Pandemic influenza is considered catastrophic to global health, with severe economic and social effects. Consequently, a strategy for the rapid deployment of essential medical supplies used for the prevention of influenza transmission and to alleviate public panic caused by the expected shortage of such supplies needs to be developed. Therefore, we employ integrated information concepts to develop a simulated influenza medical material supply system to facilitate a rapid response to such a crisis. Various scenarios are analyzed to estimate the appropriate inventory policy needed under different pandemic influenza outbreaks, and to establish a mechanism to evaluate the necessary stockpiles of medications and other requirements in the different phases of the pandemic. This study constructed a web-based decision support system framework prototype that displayed transparent data related to medical stockpiles in each district and integrated expert opinion about the best distribution of these supplies in the influenza pandemic scenarios. A data collection system was also designed to gather information through a daily VPN transmitted into one central repository for reporting and distribution purposes. This study provides timely and transparent medical supplies distribution information that can help decision makers to make the appropriate decisions under different pandemic influenza outbreaks, and also attempts to establish a mechanism of evaluating the stockpiles and requirements in the different phases of the pandemic.

Controlling the spread of disease in schools

Pandemic and seasonal infectious diseases such as influenza may have serious negative health and economic consequences. Certain non-pharmaceutical intervention strategies--including school closures--can be implemented rapidly as a first line of defense against spread. Such interventions attempt to reduce the effective number of contacts between individuals within a community; yet the efficacy of closing schools to reduce disease transmission is unclear, and closures certainly result in significant economic impacts for caregivers who must stay at home to care for their children. Using individual-based computer simulation models to trace contacts among schoolchildren within a stereotypical school setting, we show how alternative school-based disease interventions have great potential to be as effective as traditional school closures without the corresponding loss of workforce and economic impacts.