Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Research article

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

Shawn T Brown12*, Julie HY Tai13, Rachel R Bailey13, Philip C Cooley6, William D Wheaton6, Margaret A Potter1, Ronald E Voorhees14, Megan LeJeune135, John J Grefenstette1, Donald S Burke1, Sarah M McGlone13 and Bruce Y Lee13

Author Affiliations

1 Graduate School of Public Health, University of Pittsburgh, 130 Desoto St., Pittsburgh, PA, 15261, USA

2 Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, USA

3 School of Medicine, University of Pittsburgh, 200 Meyran Ave., Suite 200, Pittsburgh, PA 15213, USA

4 Allegheny County Health Department, Pittsburgh, PA, USA

5 Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA

6 RTI International, Research Triangle Park, NC, USA

For all author emails, please log on.

BMC Public Health 2011, 11:353  doi:10.1186/1471-2458-11-353

Published: 20 May 2011

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 (R0) 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 R0 = 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 R0 = 1.2, $25,253 ($9,501 - $53,461) for R0 = 1.6, and $23,483 ($8,870 - $50,926) for R0 = 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.