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Background: Weaponized Bacillus anthracis is one of the few biological agents that can cause death and disease in sufficient numbers to devastate an urban setting. Objective: To evaluate the cost-effectiveness of strategies for prophylaxis and treatment of an aerosolized B. anthracis bioterror attack. Design: Decision analytic model. Data Sources: We derived probabilities of anthrax exposure, vaccine and treatment characteristics, and their costs and associated clinical outcomes from the medical literature and bioterrorism-preparedness experts. Target Population: Persons living and working in a large metropolitan U.S. city. Time Horizon: Patient lifetime. Perspective: Societal. Intervention: We evaluated 4 postattack strategies: no prophylaxis, vaccination alone, antibiotic prophylaxis alone, or vaccination and antibiotic prophylaxis, as well as preattack vaccination versus no vaccination. Outcome Measures: Costs, quality-adjusted life-years, life-years, and incremental cost-effectiveness. Results of Base-Case Analysis: If an aerosolized B. anthracis bioweapon attack occurs, postexposure prophylactic vaccination and antibiotic therapy for those potentially exposed is the most effective (0.33 life-year gained per person) and least costly ($355 saved per person) strategy, as compared with vaccination alone. At low baseline probabilities of attack and exposure, mass previous vaccination of a metropolitan population is more costly ($815 million for a city of 5 million people) and not more effective than no vaccination. Results of Sensitivity Analysis: If prophylactic antibiotics cannot be promptly distributed after exposure, previous vaccination may become cost-effective. Limitations: The probability of exposure and disease critically depends on the probability and mechanism of bioweapon release. Conclusions: In the event of an aerosolized B. anthracis bioweapon attack over an unvaccinated metropolitan U.S. population, postattack prophylactic vaccination and antibiotic therapy is the most effective and least expensive strategy.

As the anthrax scare unfolds, the July Senate testimony of Johns Hopkins University bioterrorism scholar Tara O'Toole, MD, sounds more prescient with each passing day. 'Many of those who would [...]

Awareness of how best to protect children in the face of terrorist attacks and other disasters is dangerously insufficient, and their unique needs have rarely--if ever--been considered in preparedness programs. [...]

Inglesby TV, O'Toole T, Henderson DA, et al. JAMA. 2002;287:2236-2252. This article reviewed and updated consensus-based recommendations for medical and public health professionals following the recent Bacillus anthracis attacks against [...]

A dosage error appeared in "CDC Offers Clinicians Help in Dealing With Anthrax" (Nov. 15, 2001, p. 1). For initial treatment of cutaneous or inhalation anthrax, the correct dose of [...]