Recorded presentation

Ran D. Balicer, MD¹, Michael Huerta, MD, MPH², Nadav Davidovitch, MD³, and Itamar Grotto, MD, MPH². (1) Tel-Aviv DHO, Israeli Ministry of Health, 27 Hagilgal st., Ramat-Gan, 52392, Israel, 972-54-757447, rbalicer@netvision.net.il, (2) Medical Corps, Army Health Branch, Israel Defense Force, Military Post 02149, Ramat-Gan, Israel, (3) Health Systems Management, Faculty for Health Sciences, Ben Gurion University, P.O. Box 653, Beer Sheva, 84105, Israel

The next influenza pandemic can be expected to spread rapidly, causing worldwide morbidity, mortality and economic disruption. Strain-specific vaccines will require months to develop, and the early stages of pandemic control will be based on the judicious use of antiviral drugs. These drugs are likely to be in short supply if not preemptively stockpiled in sufficient quantities. The extent of stockpiling should be determined in accordance with chemotherapeutic strategies designed to maximize the benefit of antivirals in a given population, such as treatment of influenza patients, post-exposure prophylaxis for contacts, pre-exposure prophylaxis for susceptibles, or combinations of the above.

We present a mathematical model for the comparison of five antiviral strategies: treatment of all influenza patients, treatment of high-risk patients, continuous pre-exposure prophylaxis – either population-wide or selective for high-risk groups, and post-exposure "ring prophylaxis" for patient household contacts. We modeled each strategy’s cost, impact on reduction in morbidity and mortality, and cost-benefit ratio.

The model showed ring prophylaxis to be the most effective strategy for utilizing antiviral drugs during a pandemic, in terms of cost-benefit ratio. This strategy reduced patient burden, hospitalization and mortality by over 40%, with an overall cost-benefit ratio of 13.3. Patient therapy, either non-selective or selectively directed at high-risk patients proved cost-beneficial as well, with ratios of 2.63 and 3.37, respectively.

Pre-pandemic stockpiling of antiviral drugs for future use in patients and their household contacts is cost-beneficial. This preliminary model can be used in order to estimate the quantities necessary for global antiviral stockpiling.

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