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Volume 15, Number 12—December 2009


Cost-effectiveness Analysis of Hospital Infection Control Response to an Epidemic Respiratory Virus Threat

Yock Young Dan, Paul A. TambyahComments to Author , Joe Sim, Jeremy Lim, Li Yang Hsu, Wai Leng Chow, Dale A. Fisher, Yue Sie Wong, and Khek Yu Ho
Author affiliations: National University Health System, Singapore (Y.Y. Dan, P.A. Tambyah, J. Sim, L.Y. Hsu, D.A. Fisher, K.Y. Ho); Singapore General Hospital, Singapore (J. Lim, W.L. Chow, Y.S. Wong)

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Table 2

Variables used in Markov mode (base case and sensitivity analysis) to compare outbreak estimates, Singapore*

Variable Description Base case Sensitivity analysis
Exposure No. persons exposed in 1 day in hospital per index case (nonlinear) 15 (average for 2 days)
6 (average for 5 days) 2–30
Secondary attack rate No. persons exposed/infected 30% Spanish influenza
10% SARS
30% pandemic (H1N1) 2009 10–100%
Incubation period Time to symptoms Spanish influenza: 2 days
SARS: 4 day
Pandemic (H1N1) 2009: 3 days 1–7
Infectious period preclinical Incubation–latent Spanish influenza: 1 day
SARS: 0 day
Pandemic (H1N1) 2009: 1 day 1–3
% Clinical versus asymptomatic Spanish influenza: 95%
SARS: 100%
Pandemic (H1N1) 2009: 95% 70–100%
% Atypical (missed) Spanish influenza: 5%
SARS: 20%
Pandemic (H1N1) 2009: 5% 0–50%
% Complication 10× mortality rate
Infective atypical Infective 4 days 1–7
Case-fatality rate % death Spanish influenza: 5%
SARS: 10%
Pandemic (H1N1) 2009: 4%
Isolation failure Transmission despite PPE/isolation 5% 0­–10%
Exposure reduction % reduction in exposure rate Alert Green 50%
Alert Yellow 80%
Alert Orange 90% 0–100%
Cost based on alert policy, direct and indirect Once
Daily recurring Activation: US$110,000
Green: US$4,000
Yellow: US$76,000
Orange: US$100,000
Cost by type of treatment, based on actual financial charges Isolation
Treatment antiviral/day
Uncomplicated influenza
Complicated influenza
Respiratory failure with mechanical ventilation US$230
Mean: US$600, Median: US$420
Mean: US$1800, Median: US$220
Mean: US$5,500, Median:US$4,660

*SARS, severe acute respiratory syndrome; PPE, personal protective equipment.

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