Page 205 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

In Chapter 8 we made an inventory of the financial costs involved with Ebola preparedness, and for the response mounted to 13 suspected cases and one confirmed case. In reality the burden of response was higher, as the RIVM was consulted over 89 times about possible cases, and MHS and curative sector probably about many more cases (39). The total costs made by the public health sector and curative sector were estimated to be € 12.6 million (range € 6.7 - € 22.5 million), or € 17.9 including overhead. Costs for preparedness exceeded costs for response and involved mainly personnel costs for activities such as coordination, developing protocols and training, and expenditure for PPE. Costs involved in Ebola preparedness and treatment as estimated in other countries were higher: Herstein et al. determined that the creation of an EVD treatment center in the US cost almost $ 1.2 million on average, and Zacharowski et al. assessed the costs for the treatment of one EVD patient over € 1 million in Ger- many (40, 41). Costs are difficult to compare however, as the patient in Germa- ny for example needed longer and more extensive treatment, and investments in infrastructure for treatment centers were included in the US and not in our study. Nevertheless, we advise for reasons of cost reduction and efficiency, to designate one ambulance service for transportation and fewer hospitals for ad- mission of possible patients with a highly infectious disease as Ebola. Through better structured regional and national coordination and standardization of in- fection prevention guidelines, further centralization of care for suspected cases for diseases as VHF or other emerging infectious is possible. Currently, during the Ebola outbreak in Congo, the ambulance sector is in process of centraliza- tion of services in the Netherlands (42). As result of these evaluations, the ‘Plat- form for Preparedness for Group A diseases’ has been installed by the RIVM, in which the curative and public health sector together with the RIVM develop blueprints for regional coordination, criteria for contingency planning and pro- cedures for centralization of care.
9.3 Additional methodological considerations
There is no standardized methodology for measuring timeliness of notification systems, which we concluded in Chapter 3, 15 years after the plea for structured evaluation of surveillance systems by Jajosky et al (13). In our analyses, we used medians to measure delays in the Dutch notification chain, and cumulative per- centages to determine sufficient timeliness according to timeframes in Chapter 2 and 5. First, our systematic literature review showed variation in measuring
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