Cost-effectiveness of live poultry import screening against avian influenza A(H7N9) for preventing human infections in Hong Kong

Abstract

BACKGROUND: The avian influenza A(H7N9) epizootic poses an important threat to human health because of its clinical severity among human cases. To date, human-to-human transmission of A(H7N9) infection remains very limited. In this study, we evaluate the cost-effectiveness of screening live poultry import against avian influenza A(H7N9) for preventing human infections in Hong Kong. METHOD: We use a susceptible-exposed-infected-recovered (SEIR) model to simulate the effects of the current poultry import screening regimens for A(H7N9) in Hong Kong which comprises (i) randomly selecting 30 poultry from each consignment for serologic screening on the farm when the consignment has completed quarantine and is ready for export; (ii) randomly selecting 30 poultry for reverse transcriptase polymerase chain reaction (RTPCR) testing immediately after the consignment has reached the Hong Kong border; and (iii) randomly selecting another 20 poultry for serologic screening if it has been more than 2 weeks since live poultry imports from the same farm have undergone serologic testing at the border. RESULTS: Compared to no screening, the current screening regimen in Hong Kong has an incremental cost-effectiveness ratio (ICER) that exceeds three times GDP per capita (around US$114,000). CONCLUSION: Our results suggest that the current screening regimen is unlikely to be cost-effective.