Abstract:
BACKGROUND:The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century. OBJECTIVE:To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies. DESIGN:Compartmental epidemic model in conjunction with a Markov model of disease progression. DATA SOURCES:Literature and expert opinion. TARGET POPULATION:Residents of a U.S. metropolitan city with a population of 8.3 million. TIME HORIZON:Lifetime. PERSPECTIVE:Societal. INTERVENTIONS:3 scenarios: 1) vaccination and antiviral pharmacotherapy in quantities similar to those currently available in the U.S. stockpile (stockpiled strategy), 2) stockpiled strategy but with expanded distribution of antiviral agents (expanded prophylaxis strategy), and 3) stockpiled strategy but with adjuvanted vaccine (expanded vaccination strategy). All scenarios assumed standard nonpharmaceutical interventions. OUTCOME MEASURES:Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS:Expanded vaccination was the most effective and cost-effective of the 3 strategies, averting 68% of infections and deaths and gaining 404 030 QALYs at $10 844 per QALY gained relative to the stockpiled strategy. RESULTS OF SENSITIVITY ANALYSIS:Expanded vaccination remained incrementally cost-effective over a wide range of assumptions. LIMITATIONS:The model assumed homogenous mixing of cases and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. We did not model interventions for children or older adults; the model is not designed to target interventions to specific groups. CONCLUSION:Expanded adjuvanted vaccination is an effective and cost-effective mitigation strategy for an influenza A (H5N1) pandemic. Expanded antiviral prophylaxis can help delay the pandemic while additional strategies are implemented. PRIMARY FUNDING SOURCE:National Institutes of Health and Agency for Healthcare Research and Quality.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Khazeni N,Hutton DW,Garber AM,Owens DKdoi
10.7326/0003-4819-151-12-200912150-00156subject
Has Abstractpub_date
2009-12-15 00:00:00pages
840-53issue
12eissn
0003-4819issn
1539-3704pii
0000605-200912150-00156journal_volume
151pub_type
杂志文章abstract:BACKGROUND:Clinical trial registries are in widespread use to promote transparency around trials and their results. OBJECTIVE:To describe characteristics of drug trials listed in ClinicalTrials.gov and examine whether the funding source of these trials is associated with favorable published outcomes. DESIGN:An observ...
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doi:10.7326/0003-4819-153-3-201008030-00006
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abstract:BACKGROUND:Current magnetic resonance techniques generate high signal from venous blood and show thrombi as filling defects. Magnetic resonance direct thrombus imaging (MRDTI) directly visualizes acute thrombus. OBJECTIVE:To determine the accuracy of MRDTI for diagnosis of acute symptomatic deep venous thrombosis (DVT...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
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abstract::The second National Health and Nutrition Examination Survey found that 26% of U.S. adults, or about 34 million people aged 20 to 75 years, are overweight. The survey used a body mass index of 27.8 kg/m2 or greater for men and 27.3 or greater for women to define overweight. Prevalence of overweight increases with advan...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-103-6-983
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abstract::It is hypothesized that peritoneal fluid might be used as an alternative vehicle for monitoring the clinical chemistry of patients on peritoneal dialyses and save these patients the venesection and resultant blood loss. Peritoneal fluid was obtained before 47.2% of 106 dialysis treatments and compared with simultaneou...
journal_title:Annals of internal medicine
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abstract::In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, critical pathways display goals for patients...
journal_title:Annals of internal medicine
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doi:10.7326/0003-4819-123-12-199512150-00008
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abstract:STUDY OBJECTIVE:To determine the association between current non-aspirin nonsteroidal anti-inflammatory drug (NSAID) use and fatal peptic ulcers or upper gastrointestinal hemorrhage. DESIGN:Nested case control study using a linked Medicaid-death certificate database. SETTING:Tennessee Medicaid enrollees aged 60 and g...
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journal_title:Annals of internal medicine
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更新日期:2001-05-15 00:00:00
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:1988-06-01 00:00:00
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更新日期:2002-10-15 00:00:00