Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission

BMC Infectious Diseases, Oct 2015

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.

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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)


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Shohini Mukerji, C. MacIntyre, Anthony Newall. Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission, BMC Infectious Diseases, 2015, pp. 413, 15, DOI: 10.1186/s12879-015-1167-6