Citation

Braithwaite RS, Fridsma D, Roberts MS. Med. Decis. Making 2006; 26(2): 182-193.

Affiliation

Section of General Internal Medicine, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA. ronald.braithwaite@med.va.gov

Copyright

(Copyright © 2006, SAGE Publishing)

DOI

10.1177/0272989X06286794

PMID

16525172

Abstract

BACKGROUND: Intentional exposures to aerosolized Bacillus anthracis spores have caused fatalities. OBJECTIVE: To evaluate the cost-effectiveness of strategies to reduce mortality from future inhalational anthrax exposures. METHODS: Computer cohort simulation of a 100,000-person single-site exposure (worst-case scenario) and a 100-person multiple-site exposure (resembling the recent US attack). For each scenario, universal vaccination and an emergency surveillance and response (ESR) system were compared with a default strategy that assumed eventual discovery of the exposure. RESULTS: If an exposure was unlikely to occur or was small in scale, neither vaccination nor an ESR system was cost-effective. If an exposure was certain and large in scale, an ESR system was more cost-effective than vaccination ($73 v. $29,600 per life-year saved), and a rapid response saved more lives than improved surveillance. CONCLUSIONS: Strategies to reduce deaths from anthrax attacks are cost-effective only if large exposures are certain. A faster response is more beneficial than enhanced surveillance.

Language: en