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Table 1 Descriptive and methodological details of identified mask and respirator economic evaluations

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

First author, year, setting Jones and Adida, 2013 [22], European contact rates Chen and Liao, 2013 [21], Taiwan Tracht et al, 2012 [11], USA Dan et al, 2009 [12], Singapore Cahill et al, 2008 [20], USA Adal et al, 1994 [19], USA Nettleman et al, 1994 [23], USA
Infection(s) Influenza epidemic Seasonal influenza Influenza A(H1N1)pdm09 Influenza A(H1N1)pdm09, SARS, 1918 Spanish influenza Influenza A(H1N1)pdm09 TB TB
Mask(s) used N95 Surgical mask N95 N95 N95, surgical mask Isolation mask, respirators: DM, HEPA with/without disposable filter Surgical cup mask, respirators: DM, DMF, HEPA
Mask intervention 1 mask/person/day for duration of epidemic (90 days). Assumed respirator use begins when 0.05 % population infected Surgical mask use and natural ventilation N95 respirator use by a varied % of the population for the duration of pandemic, starting when 0.001 % symptomatic Green 0: no intervention, Green 1: PPE for HCWs in contact with suspected cases, Yellow: full PPE for HCWs in high risk contact, Orange: PPE for HCWs in contact with medium risk Monthly stockpiling and use for duration of pandemic HCW program: respirators, fit testing and HCW medical evaluation HCW program: 20 masks/8 h shift for HCWs visiting patients in isolation
Mask intervention effectiveness Baseline effectiveness was 50 %. Intervention estimated to reduce probability of infection to 30 % or 70 % of baseline, depending on person-to-person contact rates Not explicitly reported Intervention estimated to be 50 % effective in decreasing susceptibility and 20 % effective for reducing infectivity Exposure reductions of 50, 80 and 90 % with intervention. A 5 % failure despite use of protective equipment and isolation measures Probability of transmission in 5 min encounter (varied for different % compliance for masks) Not reported Assumed respirator would prevent 25 % of HCW exposure to TB
Source of effectiveness data Estimate derived from respirator assigned protective factor (APF = 10) [29]. This was adjusted for estimated lack of training, compliance and mask quality to give APF = 2 (i.e. mask 50 % effective) Based on assumptions from previous study Chen et al. 2008 [33] where mask efficacies are assumed to be 60 %, 70 %, 80 %, or 95 % and are combined in the model with other control measures Laboratory data, Lee et al. 2008 [52], and a randomised control trial by Aiello et al. 2010 [26] that found hand hygiene and facemask together were 35-51 % effective but not facemask use alone No data cited for exposure reduction, these are assumptions. Failure rate estimate from a hospital simulation study Seet et al. 2009 [32] Laboratory data from Balazy et al. 2006 [30] used to build particle transmission model Reported none available Reported none available
Type of economic evaluation Cost-effectiveness analysis Cost-effectiveness analysis Cost-effectiveness analysis Cost-effectiveness analysis Cost-effectiveness analysis Cost-effectiveness analysis Cost-effectiveness analysis
Perspective Policy developer view Not stated Not stated Healthcare institution Not stated Not stated Not stated
Primary outcome measure Total costs of intervention Unit cost per person, per year Net savings compared to no intervention Incremental increase in cost per death averted Productivity loss to economy from absenteeism Cost of respirator use per case prevented and per life saved Minimum estimates of cost per life saved and cost per death averted
Intervention outcome measures Cases Cases Cases, deaths, hospitalisations Cases, deaths Deaths, hospitalisation, outpatient visits, absenteeism HCW PPD test conversion rates Patients isolated for suspected TB, confirmed cases pulmonary TB in patients and active pulmonary TB in HCWs
  1. PPE personal protective equipment, PPD positive protein derivative skin test, TB tuberculosis, HCW healthcare worker, SARS severe acute respiratory syndrome, HEPA high-efficiency particulate air, PARP powered air purifying respirator, DM dust-mist, DMF dust-mist-fume