Economic analysis of HPAI control in the Netherlands II: comparison of control strategies.

A combined epidemiological-economic modelling approach was used to analyse strategies for highly pathogenic avian influenza (HPAI) control for the Netherlands. The modelling framework used was InterSpread Plus (ISP), a spatially based, stochastic and dynamic simulation model. A total of eight control strategies were analysed, including pre-emptive depopulation and vaccination strategies. The analysis was carried out for three different regions in the Netherlands: high-, medium- and low-density areas (HDA, MDA and LDA, respectively). The analysis included the veterinary impact (e.g. number of infected premises and duration), but was particularly focused on the impact on direct costs (DC) and direct consequential costs. The efficient set of control strategies for HDA and MDA included strategies based on either pre-emptive depopulation only or combined vaccination and pre-emptive depopulation: D2 (pre-emptive depopulation within a radius of 2 km), RV3 + D1 (ring vaccination within a radius of 3 km and additional pre-emptive depopulation within a radius of 1 km) and PV + D1 (preventive vaccination in non-affected HDAs and pre-emptive depopulation within a radius of 1 km in the affected HDA). Although control solely based on depopulation in most cases showed to be effective for LDA, pre-emptive depopulation showed to have an additional advantage in these areas, that is, prevention of 'virus jumps' to other areas. The pros and cons of the efficient control strategies were discussed, for example, public perception and risk of export restrictions. It was concluded that for the Netherlands control of HPAI preferably should be carried out using strategies including pre-emptive depopulation with or without vaccination. Particularly, the short- and long-term implications on export, that is, indirect consequential costs (ICC) and aftermath costs of these strategies, should be analysed further.

Economic analysis of HPAI control in the Netherlands I: epidemiological modelling to support economic analysis.

Economic analysis of control strategies for contagious diseases is a necessity in the development of contingency plans. Economic impacts arising from epidemics such as highly pathogenic avian influenza (HPAI) consist of direct costs (DC), direct consequential costs (DCC), indirect consequential costs (ICC) and aftermath costs (AC). Epidemiological models to support economic analysis need to provide adequate outputs for these critical economic parameters. Of particular importance for DCC, ICC and AC is the spatial production structure of a region. Spatial simulation models are therefore particularly suited for economic analysis; however, they often require a large number of parameters. The aims of this study are (i) to provide an economic rationale of epidemiological modelling in general, (ii) to provide a transparent description of the parameterization of a spatially based epidemiological model for the analysis of HPAI control in the Netherlands and (iii) to discuss the validity and usefulness of this model for subsequent economic analysis. In the model, HPAI virus transmission occurs via local spread and animal movements. Control mechanisms include surveillance and tracing, movement restrictions and depopulation. Sensitivity analysis of key parameters indicated that the epidemiological outputs with the largest influence on the economic impacts (i.e. epidemic duration and number of farms in the movement restriction zone) were more robust than less influential indicators (i.e. number of infected farms). Economically relevant outputs for strategy comparison were most sensitive to the relative role of the different transmission parameters. The default simulation and results of the sensitivity analysis were consistent with the general outcomes of known HPAI models. Comparison was, however, limited due to the absence of some economically relevant outputs. It was concluded that the model creates economically relevant, adequate and credible output for subsequent use in economic analysis. A detailed economic analysis is presented in a subsequent article.

A multipurpose model of radiology appropriateness criteria.

RATIONALE AND OBJECTIVES: Appropriateness criteria and practice guidelines are being developed in attempts to improve the cost-effectiveness of medical care. The authors sought to make a set of radiology appropriateness criteria usable for education, computer-based decision support, and utilization review. MODEL DEVELOPMENT: Sixty clinical conditions from the American College of Radiology's appropriateness criteria were selected. To make the information more suitable for automation, the names of the imaging procedures were standardized. Indexing terms were assigned to identify clinical conditions and to distinguish between each condition's variants. Semantic relationships between terms were defined. Information about the clinical conditions and variants, radiologic procedures, indexing terms, and relationships was encoded into a standardized language for document interchange. IMPLEMENTATION: The 1,956 rows in the appropriateness criteria tables for the 60 clinical conditions and their 212 variants were mapped into references to 163 distinct imaging procedures. The system's knowledge base included 301 indexing terms and 569 additional terms. CONCLUSION: Radiology appropriateness criteria can be indexed and encoded into a form that facilitates their use and interchange. The use of open, internationally accepted standards is an important step to make such knowledge portable and suitable for integration with evolving computer-based patient record systems.