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Modeling the Logistics of Response to Anthrax Bioterrorism

Ivey School of Business, University of Western Ontario, Canada, gzaric{at}ivey.uwo.ca

Dena M. Bravata, MD, MS

Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, Stanford-UCSF Evidence-Based Practice Center, Stanford, California

Jon-Erik Cleophas Holty, MD

Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, VA Palo Alto Health Care System, Palo Alto, California

Kathryn M. McDonald, MM

Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, Stanford-UCSF Evidence-Based Practice Center, Stanford, California

Douglas K. Owens, MD, MS

Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, Stanford-UCSF Evidence-Based Practice Center, Stanford, California, VA Palo Alto Health Care System, Palo Alto, California

Margaret L. Brandeau, PhD

Department of Management Science and Engineering, Stanford University, Stanford, California

Background. A bioterrorism attack with an agent such as anthrax will require rapid deployment of medical and pharmaceutical supplies to exposed individuals. How should such a logistical system be organized? How much capacity should be built into each element of the bioterrorism response supply chain? Methods. The authors developed a compartmental model to evaluate the costs and benefits of various strategies for preattack stockpiling and postattack distribution and dispensing of medical and pharmaceutical supplies, as well as the benefits of rapid attack detection. Results. The authors show how the model can be used to address a broad range of logistical questions as well as related, nonlogistical questions (e.g., the cost-effectiveness of strategies to improve patient adherence to antibiotic regimens). They generate several key insights about appropriate strategies for local communities. First, stockpiling large local inventories of medical and pharmaceutical supplies is unlikely to be the most effective means of reducing mortality from an attack, given the availability of national and regional supplies. Instead, communities should create sufficient capacity for dispensing prophylactic antibiotics in the event of a large-scale bioterror attack. Second, improved surveillance systems can significantly reduce deaths from such an attack but only if the local community has sufficient antibiotic-dispensing capacity. Third, mortality from such an attack is significantly affected by the number of unexposed individuals seeking prophylaxis and treatment. Fourth, full adherence to treatment regimens is critical for reducing expected mortality. Conclusions. Effective preparation for response to potential bioterror attacks can avert deaths in the event of an attack. Models such as this one can help communities more effectively prepare for response to potential bioterror attacks.

Key Words: bioterror • supply chain • logistics • anthrax • emergency response.

This version was published on June 1, 2008

Medical Decision Making, Vol. 28, No. 3, 332-350 (2008)
DOI: 10.1177/0272989X07312721


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