“Principles and Standards for Benefit-Cost Analysis of Public Health Preparedness and Pandemic Mitigation Programs”

The primary goal of this paper is to outline a set of principles and standards (P&S) to be used in benefit-cost analyses of public policies and programs for public health preparedness and pandemic mitigation (PHP/PM). These policies include the stockpiling and distribution of vaccines or antiviral drugs, disease surveillance networks, social distancing measures such as school closures, and quarantines or border closures. I focus primarily on pandemic influenza in the U.S. context, though the P&S suggested here could apply to BCAs of other epidemics or pandemics in other settings. Because cost-effectiveness analysis has been more widely used in the health sector, I briefly compare it with the benefit-cost approach. I then discuss several specific issues that arise in the economic analysis of PHP/PM programs, surveying the existing literature and professional standards in each to arrive at suggested P&S. These include: modeling the macroeconomic impacts of pandemic outbreaks; modeling the effects on households of school closure policies; uncertainty; discounting; disparate impacts and equity; valuing mortality risk; and health externalities. A supplementary appendix provides a literature review on economic analysis of policies and programs for PHP/PM.