Cited by 113Influenza Virus Research StudiesHealth Systems, Economic Evaluations, Quality of LifeMathematical and Theoretical Epidemiology and Ecology Models

Would school closure for the 2009 H1N1 influenza epidemic have been worth the cost?: a computational simulation of Pennsylvania

Open access
Brown, Shawn T, Tai, Julie HY, Bailey, Rachel R, Cooley, Philip C, Wheaton, William D, Potter, Margaret A, Voorhees, Ronald E, LeJeune, Megan +4 more·2011·BMC Public Health

Abstract

BACKGROUND: During the 2009 H1N1 influenza epidemic, policy makers debated over whether, when, and how long to close schools. While closing schools could have reduced influenza transmission thereby preventing cases, deaths, and health care costs, it may also have incurred substantial costs from increased childcare needs and lost productivity by teachers and other school employees. METHODS: A combination of agent-based and Monte Carlo economic simulation modeling was used to determine the cost-benefit of closing schools (vs. not closing schools) for different durations (range: 1 to 8 weeks) and symptomatic case incidence triggers (range: 1 to 30) for the state of Pennsylvania during the 2009 H1N1 epidemic. Different scenarios varied the basic reproductive rate (R(0)) from 1.2, 1.6, to 2.0 and used case-hospitalization and case-fatality rates from the 2009 epidemic. Additional analyses determined the cost per influenza case averted of implementing school closure. RESULTS: For all scenarios explored, closing schools resulted in substantially higher net costs than not closing schools. For R(0) = 1.2, 1.6, and 2.0 epidemics, closing schools for 8 weeks would have resulted in median net costs of $21.0 billion (95% Range: $8.0 - $45.3 billion). The median cost per influenza case averted would have been $14,185 ($5,423 - $30,565) for R(0) = 1.2, $25,253 ($9,501 - $53,461) for R(0) = 1.6, and $23,483 ($8,870 - $50,926) for R(0) = 2.0. CONCLUSIONS: Our study suggests that closing schools during the 2009 H1N1 epidemic could have resulted in substantial costs to society as the potential costs of lost productivity and childcare could have far outweighed the cost savings in preventing influenza cases.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/1471-2458-11-353

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • School closures decrease the workforce in health care and other important capacities by prompting more parents to stay home with children.

    “they decrease the workforce in health care and other important capacities by prompting more parents to stay home with children”

    From Precaution and proportionality in pandemic politics: democracy, state capacity, and COVID-19-related school closures around the world (2022) · cites this paper as Brown et al. 2011

    The Methods (Economic model) say that parents of children needing care might miss work during school closures, and the Discussion describes lost parental productivity. The paper does not establish a reduction specifically in the health-care workforce or other important capacities; it models a possible effect rather than documenting that those workforces decreased. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • School closures are likely to have detrimental effects on student performance and well-being.

    “are likely to have detrimental effects on student performance and well-being (e.g. Brown et al. 2011; CDC 2020).”

    From Precaution and proportionality in pandemic politics: democracy, state capacity, and COVID-19-related school closures around the world (2022) · cites this paper as Brown et al. 2011

    The Discussion’s Limitations section identifies loss of school lunch programs as a possible negative consequence of closure, which supports a concern about student well-being. The paper does not address effects on student performance; its analysis focuses on influenza transmission and economic costs. No page number is available in our copy. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 39 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Authors
Brown, S. T., Tai, J. H., Bailey, R. R., Cooley, P. C., Wheaton, W. D., Potter, M. A., Voorhees, R. E., LeJeune, M., Grefenstette, J. J., Burke, D. S., McGlone, S. M., & Lee, B. Y.
Affiliations
  • University of Pittsburgh (US)
  • RTI International (US)
Corresponding author
Brown, Shawn T
Venue
BMC Public Health
Published
2011-05-20
Volume
11
Issue
1
Pages
353-353
ISSN
1471-2458 (ISSN-L)
OpenAlex
W1994172949
Cited by
111
References
39
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 11 · 2020: 11 · 2019: 4 · 2018: 5 · 2017: 3 · 2016: 9 · 2015: 8 · 2014: 15 · 2013: 14 · 2012: 13
FWCI
10.36
Type
journal article
Language
en
Open access
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • D-Scholarship@Pitt (University of Pittsburgh) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Johns Hopkins University
  • National Institutes of Health (5u54gm088491-10)
  • Centers for Disease Control and Prevention (1P01TP000304-03)
  • National Institute of General Medical Sciences (1U54GM088491-01-09)
  • U.S. National Library of Medicine (R01LM009132)
Topics
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mathematical and Theoretical Epidemiology and Ecology Models
Keywords
school closures, 2009 H1N1 influenza, pandemic influenza, cost-benefit analysis, basic reproduction number, productivity loss, childcare costs, influenza transmission, Pennsylvania
MeSH terms
Adolescent, Adult, Aged, Child, Child, Preschool, Disease Outbreaks, Humans, Infant, Influenza, Human, Middle Aged, Monte Carlo Method, Pennsylvania, Schools, Models, Statistical, Models, Econometric, Influenza A Virus, H1N1 Subtype, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review