Page 173 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

Costs of Ebola preparedness and response in the Netherlands 171
developing specific EVD guidelines, purchase of PPE, and training employees) and b) response to a suspected case (transportation and admission to hospital). All costs are expressed at the 2015-euro price level.
Results
EVD in the Netherlands
During the epidemic period, Dutch healthcare professionals consulted the RIVM 89 times about a possible EVD case [29]. Based on a protocol for triage and care, 13 cases were referred to an academic hospital in strict isolation, pending results of laboratory diagnostics. In all cases, results proved to be negative for EVD. However, at the request of the UN and the Dutch Government, an Ebola virus-infected UN employee was brought from a hospital in Africa to the Dutch Major Incidence Hospital (MIH) at one of the eight academic medical centres [11]. He was discharged in good health 14 days later.
General practitioners
The total 8,700 GPs in the Netherlands spent each an estimated 1-2 hours (at €62 per hour) to be informed of EVD relevant guidelines. The 50 cooperative GP services (providing care beyond normal working hours) each spent 70 to 90 hours for EVD preparedness. According to the Dutch guidelines, no PPE was used except for masks and gloves, so no additional costs were incurred for PPE storage. Overall costs averaged €1.06 million (uncertainty interval (UI) €0.76 million-€1.36 million).
Ambulance care services
For ambulance care services, the highest costs were incurred in acquisition of materials such as PPE (€0.53 million), followed by costs for coordination of pre- paredness activities (€0.41 million) (Table 1 and Table A1 and A2 Appendix File). The latter included the development of EVD-related protocols within each of the services. Twelve suspected EVD cases were transported by ambulance to a hospital. Two services adapted an ambulance for the transportation of a sus- pected case at the cost of €18,000 and €30,000, respectively (costs not included in table 1.) The AZN performed activities regarding development of protocols, policy advice, and gatherings with other organisations, resulting in costs esti- mated at €0.09 million. Mean overall costs were €1.48 million (UI: €0.89 mil- lion-€2.41 million).
8