A PDF file should load here. If you do not see its contents
the file may be temporarily unavailable at the journal website
or you do not have a PDF plug-in installed and enabled in your browser.
Alternatively, you can download the file locally and open with any standalone PDF reader:
http://www.biomedcentral.com/content/pdf/s12879-015-1167-6.pdf
Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission
Mukerji et al. BMC Infectious Diseases
Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission
Shohini Mukerji 0
C. Raina MacIntyre 0
Anthony T. Newall 0
0 School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales , Sydney, NSW , Australia
Background: There has been increasing debate surrounding mask and respirator interventions to control respiratory infection transmission in both healthcare and community settings. As decision makers are considering the recommendations they should evaluate how to provide the most efficient protection strategies with minimum costs. The aim of this review is to identify and evaluate the existing economic evaluation literature in this area and to offer advice on how future evaluations on this topic should be conducted. Methods: We searched the Scopus database for all literature on economic evaluation of mask or respirator use to control respiratory infection transmission. Reference lists from the identified studies were also manually searched. Seven studies met our inclusion criteria from the initial 806 studies identified by the search strategy and our manual search. Results: Five studies considered interventions for seasonal and/or pandemic influenza, with one also considering SARS (Severe Acute Respiratory Syndrome). The other two studies focussed on tuberculosis transmission control interventions. The settings and methodologies of the studies varied greatly. No low-middle income settings were identified. Only one of the reviewed studies cited clinical evidence to inform their mask/respirator intervention effectiveness parameters. Mask and respirator interventions were generally reported by the study authors to be cost saving or cost-effective when compared to no intervention or other control measures, however the evaluations had important limitations. Conclusions: Given the large cost differential between masks and respirators, there is a need for more comprehensive economic evaluations to compare the relative costs and benefits of these interventions in situations and settings where alternative options are potentially applicable. There are at present insufficient well conducted cost-effectiveness studies to inform decision-makers on the value for money of alternative mask/respirator options.
Respirator; Facemask; Economic evaluation; Cost-effectiveness; Influenza; Tuberculosis
-
Background
Both the World Health Organisation (WHO) and the
Centre for Disease Control (CDC) guidelines
recommend the use of a mask in low-risk settings and a
respirator in high-risk settings (e.g. during aerosol generating
procedures) to protect healthcare workers (HCWs) from
seasonal influenza [1, 2]. The use of a respirator at all
times is also advised for HCWs caring for patients with
suspected infectious tuberculosis [3, 4]. These measures
are important to protect HCWs as well as to reduce the
spread of respiratory infections within hospitals. This
can help to reduce both the costs associated with HCW
absenteeism and the costs of nosocomial infections.
Mask/respirator availability may also prove crucial in
the context of newly emerging respiratory infections,
particularly as some diseases such as SARS (Severe
Acute Respiratory Syndrome) and MERS-CoV (Middle
East Respiratory Syndrome Coronavirus) may initially
have no vaccine or treatment available, leaving
nonpharmaceutical measures as the only available protection
for HCWs. For other diseases such as pandemic
© 2015 Mukerji et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
influenza, reliance on vaccines for protection is not
always possible due to time delays in vaccine
development, manufacturing and distribution [5].
Furthermore, the stockpiling of relatively expensive
antivirals for influenza pandemics may not be cost-effective in
low and middle income settings [6].
In the absence of standardised mask/respirator
nomenclature [7], we will use the term ‘mask’ to indicate
standard surgical masks, also referred to as “medical
masks” in some countries. These are not specially
engineered to protect the wearer from aerosol transmission
of droplet nuclei and viral particles [8, 9]. ‘Respirator’
will be used to denote all personal protective facemasks
engineered for filtration and fit to prevent the
transmission of respiratory viruses and aerosol droplets. Several
air purifying respirators that filter the (...truncated)