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

The DOI matches its Crossref record; 38 of the 39 references it cites were found in a registry or an index.

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

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Brown, Shawn T, Tai, Julie HY, Bailey, Rachel R, Cooley, Philip C, Wheaton, William D, Potter, Margaret A, Voorhees, Ronald E, LeJeune, Megan, Grefenstette, John J, Burke, Donald S, McGlone, Sarah M, Lee, Bruce Y·2011·BMC Public Health
DOI 10.1186/1471-2458-11-353PMC PMC3119163
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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.

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Figure 1 The location and size of Pennsylvania schools.
Figure 1 The location and size of Pennsylvania schools.CC BY · PubMed Central
Figure 2 Percent of selected populations infected for school-aged children, persons not going to school, and the total population in the state of Pennsylvania for the three R0's explored.
Figure 2 Percent of selected populations infected for school-aged children, persons not going to school, and the total population in the state of Pennsylvania for the three R0's explored.CC BY · PubMed Central
Figure 3 Estimated cost of disease due to influenza for school closure policies of varying length for the three R0's explored in the state of Pennsylvania (See Equation (2) in text). Error bars give the 5% and 95% distributions.
Figure 3 Estimated cost of disease due to influenza for school closure policies of varying length for the three R0's explored in the state of Pennsylvania (See Equation (2) in text). Error bars give the 5% and 95% distributions.CC BY · PubMed Central
Figure 4 Estimated costs due to school closure for policies of varying length for the three R0's explored in the state of Pennsylvania (See Equation (3) in text). Error bars give the 5% and 95% distributions.
Figure 4 Estimated costs due to school closure for policies of varying length for the three R0's explored in the state of Pennsylvania (See Equation (3) in text). Error bars give the 5% and 95% distributions.CC BY · PubMed Central
Figure 5 Estimated total overall costs for school closure policies of varying length for the three R0's explored in the state of Pennsylvania. Error bars give the 5% and 95% distributions.
Figure 5 Estimated total overall costs for school closure policies of varying length for the three R0's explored in the state of Pennsylvania. Error bars give the 5% and 95% distributions.CC BY · PubMed Central
Figure 6 Median net cost for school closure policies of varying length for the three R0's explored in the state of Pennsylvania. Error bars give the 5% and 95% distributions.
Figure 6 Median net cost for school closure policies of varying length for the three R0's explored in the state of Pennsylvania. Error bars give the 5% and 95% distributions.CC BY · PubMed Central
Figure 7 Median net cost for school closure policies of varying length and case fatality rate (CFR). Error bars give the 5% and 95% distributions.
Figure 7 Median net cost for school closure policies of varying length and case fatality rate (CFR). Error bars give the 5% and 95% distributions.CC BY · PubMed Central

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Research works printed but not linked: 3

  1. Centers for Disease Control and Prevention: Interim Pre-Pandemic planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States. Volume 2010. 2009
  2. American Medical Association: Socioeconomics of Medical Practice. Volume 69. Edited by: Gonzales M. Chicago, Il. 1997, American Medical Association, 107-
  3. Centers for Medicare and Services: In Services USDoHH, ed. 2009

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Metadata

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
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2011-05-20
Volume
11
Issue
1
Pages
353-353
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/1471-2458-11-353
PMC
PMC3119163
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
Licence
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
  • Physical Sciences › Mathematics › Applied Mathematics › 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

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