Economics of Neuraminidase Inhibitor Stockpiling for Pandemic Influenza, Singapore

We compared strategies for stock piling neuraminidase inhibitors to treat and prevent influenza in Singapore. Cost-benefit and cost-effectiveness analyses, with Monte Carlo simulations, were used to determine economic outcomes. A pandemic in a population of 4.2 million would result in an estimated 525-1,775 deaths, 10,700-38,600 hospitalization days, and economic costs of 0.7 dollars to 2.2 billion Singapore dollars. The treatment-only strategy had optimal economic benefits: stock piles of antiviral agents for 40% of the population would save an estimated 418 lives and 414 million dollars, at a cost of 52.6 million dollars per shelf-life cycle of the stock pile. Prophylaxis was economically beneficial in high-risk subpopulations, which account for 78% of deaths, and in pandemics in which the death rate was >0.6%. Prophylaxis for pandemics with a 5% case-fatality rate would save 50,000 lives and 81 billion dollars. These models can help policymakers weigh the options for pandemic planning.