Page 178 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

176 Chapter 8
In this study, we included a range of organisations and factors, but certain cost items could not be included. Costs of adjusting isolation units to be prepared for a suspected EVD patient were not included, as only minor adjustments were re- quired. In addition, two unforeseen cases came up at emergency departments of peripheral hospitals, leading to extra time investments and costs for these hospitals. Air transportation of the EVD patient from Africa to Amsterdam also led to substantial costs, up to $200,000 (€162,000) according to a newspaper report (https://www.washingtonpost.com/news/federal-eye/wp/2014/10/28/ the-world-relies-on-this-one-company-to-fly-ebola-patients/?utm_ter- m=.82a41fcd4088). EVD-related costs were also incurred by institutions outside the scope of our study, such as the Ministry of Health, Welfare and Sport, the Inspectorate of Health, international aid organisations working in the Nether- lands, and umbrella organisations of hospitals, GPs, MHSs, and GHOR organisa- tions (Geneeskundige Hulpverleningsorganisatie in de Regio). GHOR organisa- tions, which are targeted at local safety issues and collaborate with MHSs, po- lice, fire service, etc., spent variable time on EVD, according to key professionals of four GHOR organisations. To be prepared for EBV, one organisation spent only 10 hours on EVD whereas another spent 500 hours, leading to substantial costs. Erasmus Medical Center virological laboratory was involved with the de- ployment of a mobile laboratory in Sierra Leone [31]. This was a support offered by the Dutch government to Sierra Leone that was independent from the Dutch preparedness and response, and therefore outside of the scope of the current cost analysis. Furthermore, EVD costs beyond the healthcare domain were experienced by public transportation, waste management, and undertaker’s businesses. Finally, our interviews were conducted more than a year after the threat of EVD, leading perhaps to recall bias and to underestimation of costs, as seen in other publications [32, 33]. Therefore, our reported total costs of EVD preparedness and response in the Netherlands should be regarded as the best possible estimate, with a broad uncertainty interval.
We found a large variation in hospital costs and ambulance care service costs independent of the size of the hospitals and ambulance care services. The costs of material and training in these organisations depended highly on the number of staff involved with the management of a possible EVD case. Such personnel was trained extensively in donning and doffing PPE in anticipation of transportation and admission of EVD cases. In addition, costs varied for man- agement of admission of possible cases in an academic hospital, depending on the necessity to close beds in the same ward or to allocate an isolation unit es- pecially for EVD. Also, a large variation was observed in the activities and hours