Economic considerations in risk management: lessons learned from H1N1 influenza

The objective of this review study is to improve the proficiency of cost calculation and forecasting in pandemic risk management. The 2009 A/H1N1 influenza pandemic has generated additional data and triggered new studies that open debate over the optimal strategy for handling a pandemic. A point of improvement for the risk analysis of such crises that is often mentioned in lessons-learned documents from the World Health Organization and governments is the need for cost estimation of the pandemic response. The assessment of costs during a pandemic poses particular problems related to the appropriate modeling of the characteristic of the virus and the direct effects of an intervention and its impact on costs. Further difficulties arise when trying to relate those costs to overall societal welfare, such as choosing the appropriate societal costs for an intervention or assessing the value of statistical life. In this study, we explore the lessons learned and innovation emerging from the past crisis, with a focus on studies covering high-income countries. We review a number of academic studies and organizational documents that provide cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009. Our comparative analysis reviews each study’s type of intervention, epidemiological model, type of costs included and cost-utility results with a possible conversion to cost-benefit. The result is an extensive reflection on the parameters that may drive the pandemic costs and the appropriate response, which is unique to our knowledge in both the breadth of coverage and the novelty of selected studies. At the cross-disciplinary level, this study stresses the need for an economic efficiency analysis in the risk governance process to distribute financial resources in the most efficient way.