Page 179 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

Costs of Ebola preparedness and response in the Netherlands 177
spent by professionals from several MHSs: 3 of the 6 we interviewed developed their own regional EVD guidelines, whereas the others relied on the national guidelines. Two of the MHSs participated in a regional training program, while the others did not. Most MHS variation could be explained by communication and collaboration with other professionals in the region, informing general pop- ulation, and events linked to possible cases in the region.
Up to now only a few publications have provided estimates of costs of pre- paredness and treatment of suspected EVD cases in the Western world. Her- stein et al. assessed the costs incurred to establish an Ebola treatment center in 55 US hospitals [20] and found the mean total hospital costs to create such a facility were $1,197,993. Zacharowski described the treatment and costs of a Ugandan medical doctor with EVD at a German Hospital [21, 34]. Total costs of the transfer, treatment, and management of that patient exceeded €1 million. Given the severe illness and need for lengthy intensive care, the costs exceeded those associated with the EVD patient in the Netherlands (€236,209), even if we add transfer costs of €162,000.
The Ebola outbreak urged organisations in both clinical care and public health sectors to be prepared for the introduction of a highly contagious infec- tious disease. Close collaboration between but also within these organisations has led each to a better understanding of the others’ operating procedures. In addition, organisations have learned important practical lessons. For example, the location of a high-level isolation unit in the hospital proved to be important and is more favourable near the ambulance entrance [35]. Additionally, the pos- sible presence of an EVD case led to anxiety and uneasiness among HCWs and their families, which had to be addressed in information meetings [4].
A critical appraisal of this costing study also raises suggestions for improve- ments. At the start of the epidemic neither ambulance services nor hospitals had extensive operating procedures for preparedness and management of a suspected EVD case. All the hospitals in which we conducted interviews experi- enced internal debates regarding the proper materials, shortage of PPE supplies and, as a result, higher costs when extra materials had to be purchased. Na- tional standard guidelines would have been helpful and efficient, for example, regarding the donning and doffing procedures and the appropriate PPE [25]. In order to alleviate potential shortages of materials, it may be useful to build a temporary nationwide supply chain when an epidemic threatens [36].
This study demonstrated that ambulance care services and hospitals expe- rienced far more costs for preparedness activities than for response activities. Given the small size of the Netherlands and the few cases evaluated for EVD in
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