Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 15, Number 12—December 2009
Research

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)

Main Article

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
US$25
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.

Main Article

Page created: December 09, 2010
Page updated: December 09, 2010
Page reviewed: December 09, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external