Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T05:35:18.323Z Has data issue: false hasContentIssue false
  • English
  • Français

Medical Spending for the 2001 Anthrax Letter Attacks

Published online by Cambridge University Press:  12 November 2018

Nicholas A. Zacchia  and
Ketra Schmitt
Nicholas A. Zacchia*
Affiliation:
University of British Columbia, Vancouver, British Columbia, Canada
Ketra Schmitt
Affiliation:
Concordia University, Montreal, Quebec
*
Correspondence and reprint requests to Nicholas A. Zacchia, University of British Columbia, 2360 E Mall, Vancouver, BC V6T 1Z3 (e-mail: Canada nickzacchia@gmail.com).
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

This paper assesses the total medical costs associated with the US anthrax letter attacks of 2001. This information can be used to inform policies, which may help mitigate the potential economic impacts of similar bioterrorist attacks.

Methods

Journal publications and news reports were reviewed to establish the number of people who were exposed, were potentially exposed, received prophylactics, and became ill. Where available, cost data from the anthrax letter attacks were used. Where data were unavailable, high, low, and best cost estimates were developed from the broader literature to create a cost model and establish economic impacts.

Results

Medical spending totaled approximately $177 million.

Conclusions

The largest expenditures stemmed from self-initiated prophylaxis (worried well): people who sought prophylactic treatment without any indication that they had been exposed to anthrax letters. This highlights an area of focus for mitigating the economic impacts of future disasters. (Disaster Med Public Health Preparedness. 2019;13:539-546)

Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 3 , June 2019 , pp. 539 - 546
Copyright
Copyright © 2018 Society for Disaster Medicine and Public Health, Inc. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Prior, SD. Who You Gonna Call? Responding to a Medical Emergency With the Strategic National Stockpile [tech.rep.]. Washington, DC: Center for Technology and National Security Policy; 2004.Google Scholar
2. Kaufmann, AF, Meltzer, MI, Schmid, GP. The economic impact of a bioterrorist attack: are prevention and postattack intervention programs justifiable? Emerg Infect Dis. 1997;3(2):83-94. doi: 10.3201/eid0302.970201Google Scholar
3. Fowler, RA, Sanders, GD, Bravata, DM, et al. Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax. Ann Intern Med . 2005;142(8):601-610. doi: 10.7326/0003-4819-142-8-200504190-00008Google Scholar
4. Lee, B, Gordon, P, Moore, JE, et al. Simulating the economic impacts of a hypothetical bio-terrorist attack: a sports stadium case. J Homel Secur Emerg Manag. 2002;5(1):1-20. doi: 10.2202/1547-7355.1437Google Scholar
5. Candreva, PJ, Jones, LR. Congressional delegation of spending power to the Defense Department in the post-9 -11 period. Public Budg Finance. 2005;25(4):1-19.Google Scholar
6. Joyce, PG. Public Budg Finance. Federal budgeting after September 11th: a whole new ballgame, or is it déjà vu all over again? 2005;25(1):15-31.10.1111/j.0275-1100.2005.00352.xGoogle Scholar
7. Donahue, AK, Robbins, MD, Simonsen, B. Taxes, time, and support for security. Public Budg Finance. 2008;28(2):69-86.Google Scholar
8. Donahue, AK, Joyce, PG. A framework for analyzing emergency management with an application to federal budgeting. Public Adm Rev. 2001;61(6):728-740.Google Scholar
9. Frey, BS, Luechinger, S, Stutzer, A. Calculating tragedy: assessing the costs of terrorism. J Econ Surv. 2007;21(1):1-24.10.1111/j.1467-6419.2007.00505.xGoogle Scholar
10. Gordon, P, Moore, JE, Richardson, HW. Organisation for Economic Co-operation and Development / International Transport Forum Joint Transport Research Centre Discussion Paper No. 2008/22. Economic Impact Analysis of Terrorism Events: Recent Methodological Advances and Findings [tech.rep.]. https://doi.org/10.1787/228775313070. Accessed October 10, 2018.Google Scholar
11. Rose, AZ. A framework for analyzing the total economic impacts of terrorist attacks and natural disasters. J Homel Secur Emerg Manag. 2009;6(1):1-27. doi: 10.2202/1547-7355.1399.Google Scholar
12. Schmitt, K, Zacchia, NA. Total decontamination cost of the anthrax letter attacks. Biosecur Bioterror. 2012;10(1):98-107.10.1089/bsp.2010.0053Google Scholar
13. Greene, CM, Reefhuis, J, Tan, C, et al. Epidemiologic investigations of bioterrorism-related anthrax, New Jersey, 2001. Emerg Infect Dis. 2002;8(10):1048-1055. doi: 10.3201/eid0810.020329Google Scholar
14. Jernigan, DB, Raghunathan, PL, Bell, BP, et al. Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Emerg Infect Dis. 2002;8(10):1019-1028. doi: 10.3201/eid0810.020353Google Scholar
15. Mott, JA, Treadwell, TA, Hennessy, TW, et al. Call-tracking data and the public health response to bioterrorism-related anthrax. Emerg Infect Dis. 2002;8(10):1088-1092. doi: 10.3201/eid0810.020355Google Scholar
16. Sheppard, B, Rubin, GJ, Wardman, JK, et al. Terrorism and dispelling the myth of a panic prone public. J Public Health Policy. 2006;27(3):219-245.Google Scholar
17. Belongia, EA, Kieke, B, Lynfield, R, et al. Demand for prophylaxis after bioterrorism-related anthrax cases, 2001. Emerg Infect Dis. 2005;11(1):42-47. doi: 10.3201/eid1101.040272Google Scholar
18. M’ikanatha, NM, Julian, KG, Kunselman, AR, et al. Patients’ request for and emergency physicians' prescription of antimicrobial prophylaxis for anthrax during the 2001 bioterrorism-related outbreak. BMC Public Health. 2005;5(1):1-5. doi: 10.1186/1471-2458-5-2Google Scholar
19. Shaffer, D, Armstrong, G, Higgins, K, et al. Increased US prescription trends associated with the CDC Bacillus anthracis antimicrobial postexposure prophylaxis campaign. Pharmacoepidemiol Drug Saf. 2003;12(3):177-182.Google Scholar
20. US Government Accountability Office. US Postal Service Better Guidance Is Needed to Ensure an Appropriate Response to Anthrax Contamination [tech. rep]. Washington, DC: US Government Accountability Office; 2004.Google Scholar
21. Pennsylvania Department of Health. Pennsylvania Department of Health Health Alert 13 [tech. rep.]. http://www.health.state.pa.us/pdf/healthalerts/alert13.pdf. Published 2001. Accessed October 10, 2018.Google Scholar
22. Centers for Disease Control and Prevention. Update: Investigation of Bioterrorism-Related Anthrax and Interim Guidelines for Exposure Management and Antimicrobial Therapy, October 2001. MMWR Morb Mortal Wkly Rep. 2001;50(42):909-919.Google Scholar
23. Centers for Disease Control and Prevention. Suspected Cutaneous Anthrax in a Laboratory Worker –Texas. MMWR Morb Mortal Wkly Rep. 2002;51(13):279-281.Google Scholar
24. US Centers for Disease Control and Prevention. CDC Statement Regarding Postal and Other Mailroom Facilities in the Metropolitan Washington DC Area [tech. rep.]. https://stacks.cdc.gov/view/cdc/24961. Published 2000. Accessed October 10, 2018.Google Scholar
25. US Government Accountability Office. Bioterrorism Public Health Response to Anthrax Incidents of 2001 [tech. rep.]. Washington, DC: US Government Accountability Office; 2003 October.Google Scholar
26. US Department of Health & Human Services. HHS, Bayer Agree to Cipro Purchase [tech. rep.]. https://wayback.archive-it.org/3926/20130930185156/http://archive.hhs.gov/news/press/2001pres/20011024.html. Published 2001. Accessed October 10, 2018.Google Scholar
27. DeSalvo, KB, Block, JP. The anthrax scare: US healthcare as usual. MedGenMed. 2002;4(1):1-3.Google Scholar
28. Walsh, JJ, Pesik, N, Quinn, CP, et al. A case of naturally acquired inhalation anthrax: clinical care and analyses of anti-protective antigen immunoglobulin G and lethal factor. Clin Infect Dis. 2007;44(7):968-971.Google Scholar
29. Halpern, NA, Pastores, SM, Thaler, HT, et al. Critical care medicine use and cost among Medicare beneficiaries 1995 -2000: major discrepancies between two United States federal Medicare databases. Crit Care Med. 2007;35(3):692-699.Google Scholar
30. Committee on Prepositioned Medical Countermeasures for the Public; Institute of Medicine; Stroud C, Viswanathan K, Powell T, et al. eds. Antibiotics for anthrax postexposure prophylaxis. Prepositioning Antibiotics for Anthrax. https://www.ncbi.nlm.nih.gov/books/NBK190044/. Published September 30, 2011. Acessed October 10, 2018.Google Scholar
31. Shepard, CW, Soriano-Gabarro, M, Zell, ER, et al. Antimicrobial postexposure prophylaxis for anthrax: adverse events and adherence. Emerg Infect Dis. 2002;8(10):1124-1132.Google Scholar
32. Dewan, PK, Fry, AM, Laserson, K, et al. Inhalational anthrax outbreak among postal workers, Washington, DC, 2001. Emerg Infect Dis. 2002;8(10):1066-1072.Google Scholar
33. Weis, CP, Intrepido, AJ, Miller, AK, et al. Secondary aerosolization of viable Bacillus anthracis spores in a contaminated US Senate Office. JAMA. 2002;288(22):2853-2858.Google Scholar
34. US Centers for Disease Control and Prevention. Roundtable on the Psychosocial Challenges Posed by a Radiological Terrorism Incident. https://emergency.cdc.gov/radiation/pdf/rt-psychosocial.pdf. Published 2005. Accessed October 10, 2018.Google Scholar
35. Stone, FP. The “worried well” response to cbrn events: analysis and solutions. The Counterproliferation Papers Future Warfare Series No. 40. United States Air Force Counterproliferation Center. http://www.dtic.mil/dtic/tr/fulltext/u2/a475818.pdf. Published 2007. Accessed October 10, 2018.Google Scholar
36. Fischhoff, B. Communicating about the risks of terrorism (or anything else). Am Psychol. 2011;66(6):520-531.Google Scholar
37. Alexander, DA, Klein, S. Biochemical terrorism: too awful to contemplate, too serious to ignore: subjective literature review. Br J Psychiatry. 2003;183(6):491-497.Google Scholar
38. Dockins, C, Maguire, K, Simon, N, et al. Value of statistical life analysis and environmental policy: a white paper. US Environmental Protection Agency, National Center for Environmental Economics. https://www.epa.gov/sites/production/files/2017-12/documents/ee-0483_all.pdf. Published 2004. Accessed October 10, 2018.Google Scholar
39. Mrozek, JR, Taylor, LO. What determines the value of life? J Policy Anal Manage. 2002;21(2):253-270.Google Scholar
40. Viscusi, WK, Aldy, JE. The value of a statistical life: a critical review of market estimates throughout the world. J Risk Uncertain. 2003;27(1):5-76.Google Scholar
41. Bravata, DM, Zaric, GS, Holty, J-EC, et al. Reducing mortality from anthrax bioterrorism: strategies for stockpiling and dispensing medical and pharmaceutical supplies. Biosecur Bioterror. 2006;4(3):244-262.Google Scholar
42. Timbie, JW, Ringel, JS, Fox, DS, et al. Systematic review of strategies to manage and allocate scarce resources during mass casualty events. Ann Emerg Med. 2013;61(6):677-689.Google Scholar