ArticleBMC public health2011
Would school closure for the 2009 H1N1 influenza epidemic have been worth the cost?: a computational simulation of Pennsylvania.
Article in BMC public health, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
59 citing papers in PubMed, 6 syntheses or guidelines pooled it, 114 citations in OpenAlex.
- The Economic Value of Non-pharmaceutical Interventions for Influenza and COVID-19: A Systematic Review.Applied health economics and health policy · 2026Pooled it
- A Systematic Review of the Costs Relating to Non-pharmaceutical Interventions Against Infectious Disease Outbreaks.Applied health economics and health policy · 2021Pooled it
- School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review.The Lancet. Child & adolescent health · 2020Pooled it
- HIV, Sexually Transmitted Infection, and Substance Use Continuum of Care Interventions Among Criminal Justice-Involved Black Men Who Have Sex With Men: A Systematic Review.American journal of public health · 2018Pooled it
- Disease prediction models and operational readiness.PloS one · 2014Pooled it
- Systematic review of economic evaluations of preparedness strategies and interventions against influenza pandemics.PloS one · 2012Pooled it
- The unintended health effects of US COVID-19 lockdowns: a systematic review.Health affairs scholar · 2025Review
- Optimal pandemic control strategies and cost-effectiveness of COVID-19 non-pharmaceutical interventions in the United States.BMC global and public health · 2025Article
- The role of economic evaluation in modelling public health and social measures for pandemic policy: a systematic review.Cost effectiveness and resource allocation : C/E · 2024Article
- Cost effectiveness of preemptive school closures to mitigate pandemic influenza outbreaks of differing severity in the United States.BMC public health · 2024Article
- The Impact of the Good Behavior Game on Risk for Drug Use Disorder in an Agent-Based Model of Southern Sweden.Journal of studies on alcohol and drugs · 2023Article
- The FLURESP European commission project: cost-effectiveness assessment of ten public health measures against influenza in Italy: is there an interest in COVID-19 pandemic?Cost effectiveness and resource allocation : C/E · 2023Article
- Assessment Model for Rapid Suppression of SARS-CoV-2 Transmission under Government Control.Tropical medicine and infectious disease · 2022Article
- Economic evaluations of interventions against viral pandemics: a scoping review.Public health · 2022Article
- Mitigating COVID-19 Transmission in Schools With Digital Contact Tracing.IEEE transactions on computational social systems · 2021Article
- Review
- Disparities in COVID-19 mortality by county racial composition and the role of spring social distancing measures.Economics and human biology · 2021Article
- Emotional Attitudes of Chinese Citizens on Social Distancing During the COVID-19 Outbreak: Analysis of Social Media Data.JMIR medical informatics · 2021Article
- Global economic impacts of COVID-19 lockdown measures stand out in high-frequency shipping data.PloS one · 2021Article
- Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature.The European journal of health economics : HEPAC : health economics in prevention and care · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundDuring the 2009 H1N1 influenza epidemic, policy makers debated over whether, when, and how long to close schools. While closing schools could have reduced influenza transmission thereby preventing cases, deaths, and health care costs, it may also have incurred substantial costs from increased childcare needs and lost productivity by teachers and other school employees.
methodsA combination of agent-based and Monte Carlo economic simulation modeling was used to determine the cost-benefit of closing schools (vs. not closing schools) for different durations (range: 1 to 8 weeks) and symptomatic case incidence triggers (range: 1 to 30) for the state of Pennsylvania during the 2009 H1N1 epidemic. Different scenarios varied the basic reproductive rate (R(0)) from 1.2, 1.6, to 2.0 and used case-hospitalization and case-fatality rates from the 2009 epidemic. Additional analyses determined the cost per influenza case averted of implementing school closure.
resultsFor all scenarios explored, closing schools resulted in substantially higher net costs than not closing schools. For R(0) = 1.2, 1.6, and 2.0 epidemics, closing schools for 8 weeks would have resulted in median net costs of $21.0 billion (95% Range: $8.0 - $45.3 billion). The median cost per influenza case averted would have been $14,185 ($5,423 - $30,565) for R(0) = 1.2, $25,253 ($9,501 - $53,461) for R(0) = 1.6, and $23,483 ($8,870 - $50,926) for R(0) = 2.0.
conclusionsOur study suggests that closing schools during the 2009 H1N1 epidemic could have resulted in substantial costs to society as the potential costs of lost productivity and childcare could have far outweighed the cost savings in preventing influenza cases.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.