Page 172 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

170 Chapter 8
hospitals (both selected for diagnostics only and for additional long-term care), and the Erasmus Medical Center virological laboratory. This information was gathered through face-to-face interviews with professionals such as infection prevention experts, microbiologists, and virologists. One MHS consultant on in- fectious diseases control was interviewed face-to-face to obtain the time spent on activities for EVD preparedness and response, and five other MHS consult- ants were interviewed by phone. For RIVM, staff hours assigned to EVD prepar- edness and response were retrieved from a time-recording system. The number of ambulance transportations of suspected EVD cases was retrieved from the RIVM database of suspected EVD cases, along with the number of hospitalisa- tions. Data on length of hospital stays, costs of laboratory tests, personal protec- tive equipment (PPE) and other equipment, additional cleaning and disinfection were acquired from the individual organisations. The Erasmus Medical Center performed diagnostics not only for EVD but also for alternative diagnoses such as other hemorrhagic diseases and malaria.
Personnel costs were calculated by multiplying a person’s hourly wages (ac- cording to the middle step plus 1 of the relevant salary scale per discipline) by 1.39 for social obligations, vacation bonus etc., and by the hours expended on EVD [28]. Besides these base case costs we present costs including overhead, depreciation and housing costs by using higher rates for staff time. Tariffs were already available for RIVM and MHSs. For hospitals, and GPs, we added 44% to the wages, following the Dutch manual for economic evaluations [28]. For ambulance services, wages were added-up by 20%, based on real data from NZA (with lower costs for overhead and housing). The costs for admission to a high-level isolation unit were based on the list-price online of admission to an intensive care unit from which the costs of labour hours were subtracted, since these were calculated separately [28].
We present mean cost per type of healthcare institution, as well as a range of minimum and maximum costs. Furthermore we extrapolated these estimates to all healthcare institutions in the Netherlands by multiplying mean, minimum and maximum costs with the number of total organisations involved. Mean costs related to transportation and hospital care of suspected EBV cases (i.e., cost of response) were multiplied with the total number of transporta- tions and hospital admissions of suspected EBV cases. Costs related to the sin- gle EVD-diagnosed UN worker (hospitalisation, diagnostics, transportation by ambulance, and MHS activities) were subtracted from the costs of the separate organisations to avoid double-counting. For ambulance care services and ac- ademic hospitals, costs were further split into a) costs for preparedness (i.e.,