The FLURESP European Commission project: Cost-Effectiveness assessment of eight public health measures against influenza in Italy: is there an interest in COVID-19 pandemic?

Background: The FLURESP project is a public health research funded by the European Commission, with the objective to design a methodological framework to assess and compare the cost-effectiveness of existing public health measures against human influenza pandemics in four target countries: France, Italy, Poland and Romania. This article presents the results relevant to the Italian health system using a dataset specifically collected for this purpose. As most of interventions against human influenza are relavant against other respiratory diseases pandemics, potential interests in COVID-19 are discussed. Methods: : Eight public health measures against human influenza pandemics pandemic were selected to be also relevant to other respiratory virus pandemics such as COVID 19: 1) individual (hand washing, using masks), 2) border control (quarantine, fever screening, border closure), 3) community infection (school closure, class dismissal, social distancing, limitation of public transport), 4) reduction of secondary infections (implementation of antibiotic therapy guidelines), 5) pneumococcal vaccination for at-risk people, 6) development of Intensive Care Unit (ICU) capacity, 7) implementation of life support equipments in ICU and 8) screening interventions (virus testing).The outcome "achieving a mortality reduction of higher or equal to 40%” has been selected as a meaningful effectiveness criteria from the public health perspective. Cost distributions have been taken into account according to the Italian health system using a uniform distribution. Results: : In the frame of the major pandemic event observed in Italy in 2020, the most cost-effective strategies are “reduction of secondary infections” and “implementation of life support equipment in ICU”. The least cost-effective option during a major pandemic event is screening interventions. Conclusions: : A number of intervention strategies against human influenza pandemics appears relevant against respiratory virus pandemics in general such as the COVID-19 pandemic. These pandemics are imposing a substantial economic burden in Italy, confirming the interest of considering the cost-effectiveness of public health measures to enlighten decision making.