20th Annual Research Meeting
The premier forum for health services research
June 27-29, 2003
Nashville, TN
Economics of planning and
preparing for a
catastrophic infectious
disease event
Raymond A. Strikas, M.D.
Martin Meltzer, Ph.D.
Modeling potential responses
to smallpox as a bioterrorist
weapon
Martin Meltzer1, Inger Damon1, Jim
LeDuc1, Don Millar2
1) CDC, NCID, Atlanta, GA
2) Don Millar & Assoc., Atlanta, GA.
EID 2001, 7:959-969
The problem
Smallpox - potential weapon
Effectiveness of potential interventions
Vaccination & quarantine
Number of doses need for stockpile
1 100 199 298
0
10
20
30
40
Total cases ('000s)1
100 199 298
0
10
20
30
40
Total cases ('000s)Start
day
30
Day
45
Day
25
Results:
Vaccination + Quarantine
Days post-release
Vaccine:
33% reduction
Vaccine:
25% reduction
Site
Yr
Suscept
Cases
Doses
per case
India
1968
8%
40
34
Brazil
1969
57%
246
9
Botswana 1973
27%
30
1,667
Yugo.
1972
n/a
175
102,857
Cardiff
1962
n/a
47
19,148
N = 14
Mean
14,411
Med
2,511
Results: Doses per case
Conclusions
Most Important Variable = Transmission rate
3 infected per infective - very high
Need quarantine + vaccination to control
Need 3 P’s - stockpile alone inadequate
40 million dose stockpile - adequate
Costly if delay in response
May take 150 days to stop outbreak
The economics of preparing
for an anthrax attack
Kaufmann AF, Meltzer MI, Schmidt
GP
EID, 1997;3:83-94
Impact of an intervention after a bioterrorist attack with
anthrax: Per 100,000 exposed
Start of postattack treatment (days)
0
10
20
30
0
100
200
300
0
1
2
3
4
5
6
Outpatient visits & hospital days (1,000s)No program
Intervention 95% effective
Outpatient visits
(right scale)
Hospital days
(right scale)
Deaths
Deaths (1,000s)
Conclusions
¾Delay is costly (6 days max.)
¾Plan, prepare and practice for rapid
response
¾Can place $ value on response (see source)
Economic impact of
pandemic influenza in the
U.S.: Implications for
setting priorities
Martin Meltzer, Ph.D.
Nancy Cox, Ph.D.
Keiji Fukuda, M.D.
EID 19