Post-Attack Vaccine Plus Antibiotics Best Against Anthrax Release

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A combination of immunization plus antibiotics is the most cost-effective way to treat people who may have been exposed to Anthrax during a bioterrorism attack, a new study finds.

“Our findings make clear that combination therapy with antibiotics and vaccination is better than either treatment alone. And the best strategy is actually the least expensive,” senior researcher Dr. Douglas Owens, a professor of medicine at Stanford University’s Center for Primary Care and Outcomes Research, said in a prepared statement.

Researchers from the Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine and the University of Toronto evaluated the cost effectiveness of different methods of defending against the release of anthrax from an aircraft over a large city.

The World Health Organization has estimated that such an attack over a city of 5 million people would result in about 250,000 deaths.

Owens’ team developed a model to compare potential costs, harm and benefits of four response strategies following this type of attack: no vaccination or antibiotics; vaccination alone; antibiotics alone; or a combination of antibiotics and vaccination.

Reporting in the April 19 issue of the Annals of Internal Medicine, they conclude that a vaccination-antibiotics combination was the most effective—and least expensive—way to prevent death and disease. The intervention cost an estimated $46,099 per person and resulted in an average four-month gain of life when compared to vaccination alone. The combination approach also resulted in a net cost saving of $355 per person when compared to vaccination alone.

But the researchers stressed that these benefit can only occur if effective rapid vaccine and antibiotic distribution systems are already in place. “There must be a way to get antibiotics to a very large number of people very rapidly,” Owens said.

The study also concluded that widespread, pre-attack vaccination efforts were not cost-effective. For example, in a city of 5 million people, such an effort would cost between $500 million and $1 billion, without appreciable health benefits, according to the researchers. - http://www.bt.cdc.gov

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