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Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax.

Publication ,  Journal Article
Fowler, RA; Sanders, GD; Bravata, DM; Nouri, B; Gastwirth, JM; Peterson, D; Broker, AG; Garber, AM; Owens, DK
Published in: Ann Intern Med
April 19, 2005

BACKGROUND: Weaponized Bacillus anthracis is one of the few biological agents that can cause death and disease in sufficient numbers to devastate an urban setting. OBJECTIVE: To evaluate the cost-effectiveness of strategies for prophylaxis and treatment of an aerosolized B. anthracis bioterror attack. DESIGN: Decision analytic model. DATA SOURCES: We derived probabilities of anthrax exposure, vaccine and treatment characteristics, and their costs and associated clinical outcomes from the medical literature and bioterrorism-preparedness experts. TARGET POPULATION: Persons living and working in a large metropolitan U.S. city. TIME HORIZON: Patient lifetime. PERSPECTIVE: Societal. INTERVENTION: We evaluated 4 postattack strategies: no prophylaxis, vaccination alone, antibiotic prophylaxis alone, or vaccination and antibiotic prophylaxis, as well as preattack vaccination versus no vaccination. OUTCOME MEASURES: Costs, quality-adjusted life-years, life-years, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: If an aerosolized B. anthracis bioweapon attack occurs, postexposure prophylactic vaccination and antibiotic therapy for those potentially exposed is the most effective (0.33 life-year gained per person) and least costly (355 dollars saved per person) strategy, as compared with vaccination alone. At low baseline probabilities of attack and exposure, mass previous vaccination of a metropolitan population is more costly (815 million dollars for a city of 5 million people) and not more effective than no vaccination. RESULTS OF SENSITIVITY ANALYSIS: If prophylactic antibiotics cannot be promptly distributed after exposure, previous vaccination may become cost-effective. LIMITATIONS: The probability of exposure and disease critically depends on the probability and mechanism of bioweapon release. CONCLUSIONS: In the event of an aerosolized B. anthracis bioweapon attack over an unvaccinated metropolitan U.S. population, postattack prophylactic vaccination and antibiotic therapy is the most effective and least expensive strategy.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

April 19, 2005

Volume

142

Issue

8

Start / End Page

601 / 610

Location

United States

Related Subject Headings

  • Vaccination
  • United States
  • Sensitivity and Specificity
  • Quality-Adjusted Life Years
  • Models, Statistical
  • Humans
  • General & Internal Medicine
  • Decision Support Techniques
  • Cost-Benefit Analysis
  • Cities
 

Citation

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ICMJE
MLA
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Fowler, R. A., Sanders, G. D., Bravata, D. M., Nouri, B., Gastwirth, J. M., Peterson, D., … Owens, D. K. (2005). Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax. Ann Intern Med, 142(8), 601–610. https://doi.org/10.7326/0003-4819-142-8-200504190-00008
Fowler, Robert A., Gillian D. Sanders, Dena M. Bravata, Bahman Nouri, Jason M. Gastwirth, Dane Peterson, Allison G. Broker, Alan M. Garber, and Douglas K. Owens. “Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax.Ann Intern Med 142, no. 8 (April 19, 2005): 601–10. https://doi.org/10.7326/0003-4819-142-8-200504190-00008.
Fowler RA, Sanders GD, Bravata DM, Nouri B, Gastwirth JM, Peterson D, et al. Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax. Ann Intern Med. 2005 Apr 19;142(8):601–10.
Fowler, Robert A., et al. “Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax.Ann Intern Med, vol. 142, no. 8, Apr. 2005, pp. 601–10. Pubmed, doi:10.7326/0003-4819-142-8-200504190-00008.
Fowler RA, Sanders GD, Bravata DM, Nouri B, Gastwirth JM, Peterson D, Broker AG, Garber AM, Owens DK. Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax. Ann Intern Med. 2005 Apr 19;142(8):601–610.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

April 19, 2005

Volume

142

Issue

8

Start / End Page

601 / 610

Location

United States

Related Subject Headings

  • Vaccination
  • United States
  • Sensitivity and Specificity
  • Quality-Adjusted Life Years
  • Models, Statistical
  • Humans
  • General & Internal Medicine
  • Decision Support Techniques
  • Cost-Benefit Analysis
  • Cities