Table 2

Characteristics of full economic evaluation studies on preparedness and response measures of influenza outbreaks, expressed in Euros (base year 2017)

Study (publication year)Setting, YearPopulation (n)InterventionsComparatorEconomic evaluation outcomes
Non-pharmaceutical studies
Lankelma et al (2019)23Netherlands, 2017–2018Patients with acute RTI at the emergency department (1546 tests, 624 cases)Point-of-care-testing for Influenza before hospital admission2016–2017 influenza seasonNet savings
€388 317 (after subtraction with costs)
More than 80% of the total savings are due to the shorter length of stay and decreased hospital admissions.
The overall cost of intervention: €98 968
Laboratory costs at €72 202
Clinical aspects costs at €26 767
Orset (2018)25France, 2014200 participants, data extrapolated7-day home confinementNo interventionCosts associated with home confinement
(a) Direct costs
For adults: €742/case
For elderly: €1191/case
(b) Indirect costs
Productivity losses/case
For adults: €550.
For elderly: €125
Costs of death/case
The cost of death for children is estimated at €22–128, for adults at €63–361 and for elderly at €2667–15 389
Loss of productivity due to influenza/case
Productivity loss in case of adult sickness: €88.70 (incl. absent from work+reduced productivity)
Productivity loss in case of a sick child for the adult (mainly mother): €97.62
Sadique et al (2008)24UK, 2005Working parents with depending childrenSchool closureNo interventionCost of school closure: between €280 million—€2.8 billion/week
Cost of absenteeism: €1.4 billion
Adjusting for informal care, the cost reduced between
€552–€635 million per week.
Adjusting for the elasticity of production the cost reduced to €970 327 320—€1.1 billion per week
Tracht et al (2012)28USA, 2009–2010 influenza seasonSimulation of the USA (302 million people:73 million children, 191 million adults and 38 million seniors)Population use of face masks (N95) on the spread of a pandemicNo interventionNet savings
If masks are worn by 10% of the adult population: €418.75 billion
If masks are worn by 50% of the adult population: €501.9 billion
Economic burden, if no intervention: €728.28 billion (incl. direct and indirect costs)
Combined pharmaceutical and non-pharmaceutical strategies
Saunders-Hastings et al (2017)26Canada, n/aA simulation of Ottawa, Canada (1.2 million)
  1. Vaccination+antiviral treatment

  2. Vaccination+antiviral treatment+antiviral prophylaxis

  3. Community contact reduction+personal protective measures+isolation

  4. Community-contact reduction+personal protective measures+isolation+antiviral treatment

  5. School closure+community contact reduction+personal protective measures+quarantine

  6. All interventions

No interventionCost/LYG vs no intervention
  1. €1700/LYG

  2. €1769/LYG

  3. €4394/LYG

  4. €4447/LYG

  5. €171 590/LYG

  6. €131 679/LYG


Total economic burden
For all scenarios, the economic burden ranges between €75 758 to €1 416 351
Halder et al (2011)27Australia, 2009A community in Western Australia (30 000)Different combinations of durations of individual school closure, antiviral treatment, household antiviral prophylaxis, extended antiviral prophylaxis, 50% workplace closure, 50% community contact reductionNo interventionCost/case averted:
Antiviral drug strategies+2 weeks school closure: €396 per case averted (cost-effective)
Short-duration school closure: €820/case averted
ISC, continuously+50% workplace. continuously: €6 204/case averted
In case of 2 weeks for the above combination: €1891/case averted
ISC, continuously: €2180/case averted
Total cost, per 100 000 population
The dual strategy of individual school closure for 2 weeks (ISC) along with the 50% community contact reduction (CCR): €3.39 million
The dual strategy of continuous ISC along with the continuous—50% WP: €61.3 million.
Productivity loss due to illness and interventions per 100 000 population
ISC (cont.)+WP (cont.): €90.21 million
Combined antiviral treatment, household antiviral prophylaxis and extended antiviral prophylaxis: €4.63
Yarmand et al (2010)29USA, 2009–2010 influenza seasonNorth Carolina State University undergraduate students (23 087)VaccinationSelf-isolationHigh levels of interventions
Self-isolation is incrementally more cost-effective than vaccination
This has been presented for most of cost ratio values.
Low levels of interventions
Vaccination is incrementally more cost-effective than self-isolation
The results were robust, even in sensitivity analyses.
Sander et al (2009)30USA, n/aResidents of a 1.632-million-person city
  1. HTAP25 with a stockpile for 25% of the population

  2. HTAP50 with a stockpile for 50% of the population

  3. HTAP with an unlimited stockpile

  4. School closure for 26 weeks

  5. Prevaccination 70% of the population with a low efficacy vaccine

  6. HTAP25+school closure

  7. HTAP50+school closure

  8. HTAP+school closure

  9. Prevaccination+school closure: prevaccinating 70% population with the low-efficacy vaccine, plus closing all schools for 26 weeks

  10. Treatment only: Treating all cases with antivirals

  11. FTAP25 for household contacts and 60% of work/school contacts, stockpile for 25% of the population

  12. FTAP50 for household contacts and 60% of work/school contacts, stockpile for 50% of population

  13. FTAP for household contacts and 60% of work/school contacts, stockpile unlimited

  14. FTAP25+school closure

  15. FTAP50+school closure

  16. FTAP+school closure

No interventionCost/capita and cost-effectiveness outcomes
  1. FTAP is cost-effective (54% reduction attack rate, €119 per capita)

  2. Prevaccination (48% reduction attack rate, €131 per capita)

  3. School closure in combination with each of the above is the least cost-effective (€2 524 per capita)


ICUR of FTAP: €42 959
ICUR of prevaccination and school closure: €43 106
Cost-saving
FTAP and prepandemic vaccination are cost-saving compared with no intervention
Pharmaceutical only strategies
Khazeni et al (2009)31USA, n/aA US metropolitan city (8.3 million)
  1. Stockpiled strategy

  2. Expanded adjuvanted vaccination

  3. Expanded antiviral prophylaxis

No interventionIntervention and treatment costs
  1. Stockpiled strategy: Total cost of €30.1 million and contribution to €288 million treatment costs

  2. Expanded adjuvanted vaccination: Total cost of €179 million and contribution to €166 million treatment costs

  3. Expanded antiviral prophylaxis: Total cost of €58.4 million and contribution to €266 million treatment costs

  4. No intervention: contribution to €462 million treatment costs


Cost/QALY gained
  1. Stockpiled strategy compared with no intervention: €7894/QALY

  2. Expanded adjuvanted vaccination (at 80% effectiveness) relative to stockpiled strategy: €8600/QALY

  3. Expanded antiviral prophylaxis has a less favourable cost-effectiveness ratio than adjuvanted vaccination


Expanded adjuvanted vaccination shown to be a cost-effective intervention because it contributes to 404 030 QALYs at $10 844 per QALY gained relative to stockpiled strategy.
Balicer et al (2005)32Israel, n/aPopulation of Israel (1 618 200 cases/patients)Stockpiling with antiviral drugs
  1. Therapeutic use (all patients)

  2. Therapeutic use (high-risk patients)

  3. Pre-exposure long-term prophylaxis (all population)

  4. Pre-exposure long-term prophylaxis (high-risk population)

  5. Short-term postexposure prophylaxis for all close contacts

No interventionCBA
Therapeutic use (incl. all and high-risk patients): 2.44–3.68
Pre-exposure (incl. entire and high-risk population): 0.37–0.38
Postexposure: 2.49
Stockpiling with antiviral drugs for high-risk patients remain cost-saving strategy even if the annual probability of a pandemic remains >1 every 80 years.
Overall cost
The overall health-related costs: €56 234 057
The overall cost to the economy: €535 245 986
Workdays lost due to illness
6 536 240 or 4 days/patient
Medema et al (2004)33n/a,Developed countries (1 billion people)
  1. Egg-based vaccines with 17% population coverage

  2. Cell culture-based vaccines with 37% population coverage

No interventionCost per life-year gained
In general, vaccination is cost-effective.
Cell culture-based vaccines: €3376/LYG (cost-effective)
Cost per intervention
Egg-based: €2.6 billion
Cell culture-based: €5.87 billion
Net savings
Egg-based: €8.5 billion
Cell culture-based: €5.87 billion
Savings: €1.84 billion
  • CBA, cost-benefit ratio; CCR, community contact reduction; FTAP, full targeted antiviral prophylaxis; HTAP, household targeted antiviral prophylaxis; ICER, incremental cost-effectiveness ratio; ICUR, incremental cost-utility ratio; ISC, individual school closure; LYG, life-year gained; QALY, quality-adjusted life year; VSL, value of statistical life; WP, workplace closure.