Cost-Effectiveness of Protective Equipment Stockpiles for Reducing Essential Worker Absenteeism in a Pandemic

Abstract

Pandemics with respiratory pathogens in a globally connected world will remain a threat to critical infrastructure and society, making it crucial to provide essential workers with protective equipment quickly. This study explores the cost-effectiveness of two different strategies: 95 % efficacy single-use respirators versus reusable respirators with 99 % efficacy.<br /> I estimated the costs per absentee day averted across three pandemic scenarios: Influenza, Covid-19, and Disease X. I measured direct absenteeism with a modified SIR model and assumed the respiratory protective equipment’s filtration efficacy as the reduced chance of infection per encounter (protectiveness). I used behavioural modelling for indirect absenteeism. For each disease scenario, I compared two respiratory protective equipment stockpiling strategies in terms of their costs and protectiveness for essential workers.<br /> In all three scenarios, reusable and highly protective equipment was found to be more cost-effective than single-use, yielding €5.77 (single-use) and €3.78 (reusable) for influenza, €5.76 and €3.58 for Covid-19, and €9.72 vs €5.13 for Disease X. The more severe the pandemic scenario in death count and infections, the higher the difference in cost-effectiveness between the two stockpiling strategies (34.5 %, 37.9 %, and 47.2 %).<br /> My model suggests that keeping a reserve of reusable, highly protective elastomeric respirators might improve worker attendance during severe pandemics. This underscores the need for pathogen-agnostic research and the inclusion of essential workers beyond the healthcare sector in pandemic planning (such as agriculture, water and electricity maintenance, law enforcement) in preparing for yet unidentified pandemic pathogens.<br /> However, this study has certain limitations. The model assumes that filtration efficacy directly equates to protection, without accounting for factors such as proper fit, user compliance, and training, which significantly impact effectiveness in real-world settings. Additionally, the cost analysis focuses on procurement and storage, excluding operational expenses like distribution and disposal, which may affect the overall cost-effectiveness.<br /> Ultimately, stockpiling reusable respirators might still be a cost-effective strategy to maintain essential workforce operations and enhance pandemic resilience.